Publication Date 01/06/2011         Volume. 3 No. 5   
Information to Pharmacists

Editorial

From the desk of the editor

Well here we are in June, nearly the end of the financial year and the paperwork toil that comes with it.
Accompanied by some cold weather that I am finding it difficult to take.
This month we present with a range of very interesting articles, and what follows is a brief summary.

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News Flash

Newsflash Updates for June2011

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 June 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

Priceline & Angus & Robertson - Lessons to be learned?

Neil Retallick

Priceline’s fixed price drugs list echoes that of Angus & Robertson's imitation of online booksellers. Before more follow, consider the lessons to be learned. The demise of the Angus & Robertson and Borders retail brands from the book market is a wake-up call for all community pharmacists who are thinking they need to match online pricing for drugs. The introduction by Priceline of its $5.99 drug list might have been taken from the Angus & Robertson play book.

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Pharma-Goss: Remote Pharmacy Practice Needs Change

Rollo Manning

Pharmacy practice in remote towns in Australia needs to be evaluated against a set of criteria that will ensure consumers a long term assurance of a top quality service. Technology should be used to create a new service standard that will not have to rely on the goodwill, generosity or entrepreneurship of individual pharmacists for years to come.

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An Automated Satellite Chain Dispensing Model

Peter Sayers

The following information appeared in Drug Topics published on 15 May 2011.
It is not too difficult to see that this is one potential model of pharmacy for the immediate future.
Envisage, for example, a central pharmacy on the scale of the model illustrated servicing a chain of satelite pharmacies within, say, a 45 minute drive.
Prescriptions transmitted electronically from each satelite pharmacy (or directly from a GP) could be dispensed by the central pharmacy, saving on inventory costs, labour (in the satelites) and error costs.
Return delivery could be direct to the patient or to a satelite pharmacy.

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Pharmacy Organisations and Moving Forward

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

About eighty percent of New Zealand pharmacists work in community pharmacy. We have approximately 3,000 pharmacists on the register which translates to about 2,400 pharmacists working full or part time in the community or retail pharmacy setting. I suspect the same proportions apply to Australia. Of the pharmacists working in retail we have approximately 900 pharmacies here and an unknown number of owners, but it is reasonable to assume that operating under laws that permit pharmacists to own >51% of the shares of up to 5 pharmacies, that there are considerably fewer than 900 owners. A reasonable guess might suggest a number of 500 owners.

Comments: 2

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Here we are! And the money goes to….?

Pat Gallagher

The Australian health informatics or e-health development situation is perhaps now at a point of soaring to a bright new world, or not.
Depending on how well ‘we’ spend, between now and June 2012, the $400 million allocated to the Wave 1 and Wave 2 PCEHR development and demonstration sites now under way.
If you are not across what Wave 1 and Wave 2 refer to - then please contact the saintly editor and we will point you to the information.
If you are not across PCEHR then you may as well stop reading now
In this context I was somewhat rocked by a report that came out of the UK on 18 May 2011.
It is a UK Government Audit Report
toThe National Programme for IT in the NHS; an update on the delivery of detailed care records system (click on link).

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The Plan is to Plan

Barry Urquhart

Several Australian (snow) ski retailers and sporting good stores have introduced a fee, typically $50.00, for customers to try on skies, clothing and specialist footwear to establish the right and appropriate size. If and when the sale is transacted the fee total is credited.
The newly introduced policy is an attempt to counter the practice by customers to try on for size merchandise and then to purchase such on-line, usually from overseas suppliers.
It is an inane, inappropriate strategy which will simply foster ill-feelings and adversely impact the respective brand names, images and store customer counts.
Moreover, little consideration is being given to the profile and characteristics of the new customers who they are affronting. These people are internet savvy and primary users of social media.

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Ego trips have a dangerous destination

Harvey Mackay

Talent is God-given, be humble.  Fame is man-given, be thankful.  Conceit is self-given, be careful.
This anonymous saying is often attributed to legendary college basketball coach John Wooden.  And he surely hit the nail on the head.
I have a different way of talking about conceit in my speeches.  If you think you're indispensable, I tell my audiences, stick your finger in a bowl of water and watch the hole it leaves when you pull it out.

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Complementary Medicines – panaceas, poisons or placebos?

Loretta Marron OAM BSc

If you believe all the advertising hype, then swallowing a bucket load of complementary medicines (CMs) may be just as good as a glass or two from the fountain of youth.  While a number of these non-prescription drugs, to give them their correct name, do provide some health benefits, others either do nothing or may even make you sick.  So how do you know whether you are taking panaceas, poisons or placebos?

As a scientist and a skeptic, I’m partial to a bit of evidence, especially when it relates to my health and well-being.  When I watch a sporting hero claiming to have ‘energy’ because of a CM, or I hear that there is a natural treatment that can help me, it certainly gets my attention. 

Comments: 2

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Roles for Hospital Pharmacy Technicians

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

Since commencing practice in hospital pharmacy in the early 1980s I have always worked with hospital pharmacy technicians.  Early in my career there were middle aged ladies with names like Shirley, Joy or Sylvia and their roles included washing bottles, pre-packing bulk supplies of tablets into smaller quantities for dispensing, distributing imprest stocks of medication into ward cupboards, making up bulk supplies of disinfectants, sterilising equipment, preparing batches of stock solutions for use in manufacturing and collecting and delivering medication orders around the hospital.

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Not a pharmacist in sight but plenty of bulk supplied medicines

Rollo Manning

The reasons why a Senate Inquiry is necessary?

Ten years and $234 million of Pharmaceutical Benefits Scheme (PBS) money later there are still thousands of Aboriginal people living in remote Australia who have never met a pharmacist. All will have met a doctor, a nurse and probably a bunch of allied health professionals but no pharmacists. This is despite the fact that PBS medicines have been in abundant supply since the introduction in 1999 of special supply arrangements for remote health services.

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The ABCs of negotiating

Harvey Mackay

As a kid, I practiced the art of negotiating daily with my parents and teachers.  I continued to hone my skills as I grew, eventually buying a small struggling envelope company.  Over decades as a business owner and salesman, I've probably spent as much time in negotiations as any other part of my job.  I know you can't negotiate anything unless you absolutely know the market.  And I always let the other person talk first.

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Medicare Locals - What's in it for Pharmacy?

Neil Johnston

It will be interesting to see how Medicare Locals will shape up and genuinely provide a focus to transition patients to the full spectrum of primary care services, including pharmacy.
Recently, Nicola Roxon announced the opening of 15 Medicare Locals, and has released the list of the first wave of Medicare Locals, which will include four in NSW, five for Queensland, two each for South Australia and WA, and single Medicare Locals for Tasmania and the ACT.
The minister has also revealed the final boundaries and catchments for all Medicare Locals, which will see more delivered for NSW and WA.

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Medicare Locals - The Devil is in the Detail...and there are no Details

Neil Johnston

Medicare Locals are now emerging as a system for serving population health needs including primary health care.
GP’s are determined to make sure that the organisation is doctor-led at every level of activity, and they are very vocal about it-particularly from power-brokers from the AMA.
This does not bode well for the objectives of Medicare Locals (ML’s) – that of introducing a patient to the best forms of primary care, using the entire spectrum of pharmacy, nursing and allied health.
Unless there is a high-level of shared responsibility, it is easy to see that the only health professionals that will eventually be left standing are the doctors. All other health professionals will simply take the line of least resistance and avoid unnecessary conflict.

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Walmart, Small Pharmacies and Building Back Growth.

Neil Johnston

History repeats itself, but most of us don’t learn the lessons from history.
In 1998 Walmart, the US-based pharmacy retailer, embarked on an expansion program of opposites consisting of the development of “super-centres” while simultaneously developing a “corner store” prototype.
Thirteen years later the corner stores have grown to 155 in number and the financial return from these much smaller stores (now called Walmart Markets) is now comparable to the larger super-centres.

Comments: 1

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Mushroom compound suppresses prostate tumours

Staff Writer

A mushroom used in Asia for its medicinal benefits has been found to be 100 per cent effective in suppressing prostate tumour development in mice during early trials, new Queensland University of Technology (QUT) research shows.The compound, polysaccharopeptide (PSP), which is extracted from the 'turkey tail' mushroom, was found to target prostate cancer stem cells and suppress tumour formation in mice, an article written by senior research fellow Dr Patrick Ling in the international scientific journal PLoS ONE said.

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Tomatoes may help ward off heart disease

Staff Writer

A University of Adelaide study has shown that tomatoes may be an effective alternative to medication in lowering cholesterol and blood pressure, thus preventing cardiovascular disease.
A paper published by Dr Karin Ried in the international journal Maturitas reveals clinical evidence that a bright red pigment called lycopene found in tomatoes and to a lesser extent in watermelon, guava, papaya, pink grapefruit and rosehip has antioxidant properties that are vital to good health.

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New research shows hip fracture rates declining

Staff Writer

Deakin University research has found a drop in hip fracture rates in people over 55.
Researchers with Deakin’s School of Medicine based at Barwon Health analysed data from the Geelong Osteoporosis Study, a long-term study involving men and women living in the Barwon Statistical Division in southeastern Australia, and found that hip fracture rates had decreased by eight per cent for men and 31 per cent for women from 1994 to 2007.

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Higher vitamin D levels associated with lower relapse risk in MS

Staff Writer

A Menzies’ study published in the international renowned journal Annals of Neurology has shown for the first time that higher levels of vitamin D are associated with a lower relapse risk in multiple sclerosis (MS) sufferers.
More people are suffering with Multiple Sclerosis (MS) per capita in Tasmania than in any other state in Australia.
In fact, between 1951 and 2009 the incidence of MS in Tasmania nearly doubled.

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Capturing CO2

Staff Writer

A team of leading researchers from some of Australia's top universities and research institutes will join forces to develop new ways to capture and transform carbon dioxide, the notorious gas at the centre of the greenhouse discussion.
Recently awarded $6 million from the CSIRO's Science and Industry Endowment Fund (SIEF) the team will explore how smart materials, called metal-organic frameworks (or MOFs) can be used to capture and concentrate CO2 with minimum energy requirements.

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University of Sydney expert developing next generation biofuels

Staff Writer

The University of Sydney's Professor Thomas Maschmeyer is behind cutting edge research that could fuel the aviation industry from sustainable energy sources in the not too distant future.
Speaking recently on the ABC's The Science Show, Professor Maschmeyer said the process uses what is known as lignocellulosic feedstocks - sourced either from existing processes in the pulp and paper industry or even grass cuttings.

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Smoke detector' gene discovered in plants

Staff Writer

Researchers at The University of Western Australia have discovered a gene that allows dormant seeds buried in the soil to detect germination stimulants in bushfire smoke called karrikins.
The same gene has also been found to provide the means for plants to respond to a growth hormone called strigolactone, which controls shoot branching, the formation of beneficial fungal associations, and germination of parasitic weeds.

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New generation asthma drug could improve metabolism

Staff Writer

Formoterol, a new generation asthma medication, shows great promise for improving fat and protein metabolism, say Australian researchers, who have tested this effect in a small sample of men. The researchers present their results today at The Endocrine Society’s 93rd Annual Meeting in Boston.
The research team comprises members of Professor Ken Ho’s lab from Sydney’s Garvan Institute of Medical Research as well as Professor Ric Day, a clinical pharmacologist from St. Vincent’s Hospital.

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Liver structure could hold the key to battling diabetes

Staff Writer

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Dangerous Toxins From Genetically Modified Plants Found in Women and Fetuses

Staff Writer

Editor's Note: The Institute for Responsible Technology is a world leader in educating policy makers and the public about genetically modified (GM) foods and crops. They investigate and report their risks and impact on health, environment, the economy, and agriculture, as well as the problems associated with current research, regulation, corporate practices, and reporting.
Founded in 2003 by international bestselling author and GMO expert Jeffrey Smith, IRT has worked in more than 30 countries on 6 continents, and is credited with improving government policies and influencing consumer-buying habits.
IRT's work comes from a dedicated team of subject experts, consultants and staff who generously donate their time and experience. In addition, IRT employs media experts, social network campaigners, writers, graphic designers, communications specialists, fundraisers, outreach professionals and support staff, who operate from their Iowa office, and from virtual offices in the US.
IRT's Campaign for Healthier Eating in America mobilizes citizens, organizations, businesses, healthcare professionals, and the media, to achieve the tipping point of consumer rejection of GM foods.
The following article has been written by Jeffery Smith.

Comments: 2

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GP Super Clinics ideal training ground for student health professionals

Staff Writer

A unique program providing our future health professionals with vital practical experience at three Queensland GP Super clinics was a finalist in the Excellence in Collaborative Workforce Initiatives Category of the Workforce Council awards.
The QUT-GP Super Clinics program manager Susi Wise said the program began in 2010 to address the growing problem of finding suitable placements for health students so that they could fully qualify and practise in the community.
The students in the program are from nine health disciplines taught at QUT: nursing, dietetics and nutrition, exercise physiology, pharmacy, podiatry, psychology, social work, radiography, and medical laboratory science.

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Natural Communications

Staff Writer

Wireless signals of varying wavelengths are of increasing concern to human health.
The volume of this type of signal is increasing daily in the average home or business environment through simple appliances and electronic equipment and health concerns are centred on the possibility of tumor development, depending on exposure.
Recently WHO announced that there was now sufficient evidence to link mobile phone transmissions to the formation of gliomas, a type of brain tumor.
Now it appears that a form of "natural transmission" can exist to avoid the health risks posed by wireless transmission. It depends on "rings" of air presure that can be directed towards a pressure sensor sufficient to create binary code to generate communication between robots.

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Biomaterial aids Nerve Regeneration-Xyloglucan From Tamarind Seeds

Staff Writer

A Monash University researcher has developed a new biomaterial that encourages damaged nerves in the brain and spinal chord to regrow. The work could revolutionise treatment of nerve-based injuries and diseases, such as Parkinson’s.
PhD student Andrew Rodda was part of a Monash Materials Engineering team investigating xyloglucan, a plant-based compound derived from the seeds of the tamarind tree.
Within plants, xyloglucan plays an important role in linking cells together and Mr Rodda has been studying its effects in animals with damaged nerve cells.

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Doctors renew call for mothball ban to prevent brain damage in babies

Staff Writer

Three leading professors have welcomed last week's decision by the Australian Pesticides and Veterinary Medicine Authority to suspend the sale of naphthalene flakes for domestic use. The professors are citing a link between exposure to naphthalene and brain damage, disability and even death in babies.
Nick Evans, Associate Professor in Neonatal Medicine at the University of Sydney, commented:

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Protein Intake can Influence Weight Loss

Staff Writer

Adjusting the intake of high protein foods like meat, eggs and milk products could determine whether you become a rugby player or marathon runner and may help you lose weight, according to new research published this month in the Journal of Biological Chemistry.
Dr Stefan Broer, head of the molecular nutrition group in the ANU College of Medicine, Biology and Environment at The Australian National University, said the study by a group of ANU and Sydney researchers could potentially lead to the development of new weight-loss drugs.

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A Fresh Look at Health Insurance

Neil Johnston

Suddenly, health insurance issues are under the spotlight here in Australia through a survey published in the “Australian Health Review” May edition (The Journal of the Australian Healthcare & Hospitals Association, published by the CSIRO).
 The survey indicates that a fresh approach needs to be taken in regard to patient reimbursement for pharmaceuticals, particularly in the high-cost, non-PBS area.
Australian Health Review thanked Ken Gray from the Pharmacy Guild of Australia (Victoria Branch) for his support in the steering committee, and Roche Products (Australia) Pty Ltd (Dee Why, NSW) for providing an unrestricted research grant to carry out this study.
The unrestricted research grant was paid to the Peter MacCallum Cancer Centre and this was utilised to fund a part-time research officer to complete the project.

Roche manufactures some high cost pharmaceuticals, particularly in the anti-cancer category.
Below are the relevant media excerpts and i2P have asked Mark Coleman to research some of these health insurance issues and make relevant comments.

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Here we are! And the money goes to….?

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.

The Australian health informatics or e-health development situation is perhaps now at a point of soaring to a bright new world, or not.
Depending on how well ‘we’ spend, between now and June 2012, the $400 million allocated to the Wave 1 and Wave 2 PCEHR development and demonstration sites now under way.
If you are not across what Wave 1 and Wave 2 refer to - then please contact the saintly editor and we will point you to the information.
If you are not across PCEHR then you may as well stop reading now
In this context I was somewhat rocked by a report that came out of the UK on 18 May 2011.
It is a UK Government Audit Report
toThe National Programme for IT in the NHS; an update on the delivery of detailed care records system (click on link).

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This succinct 15 page report finds that ‘BP billions’ have been spent on a prestigious NHS project to convert paper based patient records to e-health platforms, and in short the attempt is failing.

The UK project managers, implementers and vendors have under delivered. Worse, the vendors are now asking for more money to deliver what they have failed to yet achieve.

The punch line is on page 13, in a paragraph titled:

Conclusion on value for money” – which says in part …

On this basis we conclude that the BP2.7 billion (say $A5 billion) spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of BP4.3 (about $8 billion) will be different”

Sends a shiver down the spine.

A sum of $5 billion is a lot of money to spend for what seems to be precious little benefit as a return on investment. It should remind us all that whenever any large project is proposed and before implementation starts, one of the many KPIs a project management team has to monitor and manage is to ‘follow the money”

That is - where is the money being spent and is the money being spent, as planned. In the UK case it was to save data capture, administration and data sharing time and effort of clinical care delivery to be recorded on patient records. So as to presumably change work practices gradually to the meet the many short, middle and long term goals of e-health platforms.

It was up to the UK project managers to keep asking what is it they were trying to do for the money. An overly simple prescription for effective change could be said to be – ‘remove the cost and improve the usefulness in the exchange of paper based information’.

And also, by removing the paper achieve process and practice time savings for care givers, reduce errors and attendant costs, in achieving care delivery improvements for patients.

Or in other words make it easier, faster, better, safer and useful for those working at the coal face as well as the receivers of care.

Clearly this is not yet the case in the UK. Therefore the lesson is stark and we should not ignore the warning that it could happen here as well. God knows we have had enough examples over the past decade in Australia to ram home the lessons-to-be learnt message.

Perhaps not, perhaps we might still blow it away and be asked to spend more money for the insult of suffering someone’s failure later in 2012.

What is the core warning?

My take is that everyone in the UK T1 and T2 loop, those who spent the money and those who received the money, are perfectly content with the state of affairs.

Meanwhile the people working where the money was needed to be spent are still under serviced and under supported. Ergo, only now by way of this follow-the-money post audit, from womb to tomb, does the result emerge - which is not a pretty picture.

First, foremost and simply the underlining goal of ‘e-health’ is to remove paper based transactions from as much of healthcare delivery and associated activities as possible; and do it when and where it is possible, affordably and usefully for all concerned.

To electronically reticulate this common information so that it can be shared up and down, across and throughout the three tiers of the health community: T1 - governance and policy (funding); T2 - ICT service providers and facilitators; and T3 - the coal face participants and taxpayers.

Once the project (s) start, the importance of the tiers of influence should be reversed in project management terms - so that those at the coal face become the main focus of attention.

The people who do the work will only accept and undertake change if it makes their world a better world. I said above that I suspect that every T1 and T2 player in the UK, who spent the money and got the money, thought they were doing a great job. In fact I would bet that they believed they had Plans, Specifications and ‘Standards’ that were world’s best and ‘perfect’ in being fit for purpose, theoretically.

However as we learn over and over again, in the real world, trying for theoretical perfection usually becomes the enemy of doing well. Thereby wasting money and frustrating the very people who should enjoy the fruits of the investment.

The associated factor here in Australia at present is wide spread ignorance.

Very few people employed in healthcare (Australia’s largest employer) understand the PCEHR issues as well as the relatively few insiders in T1 and T2 health informatics circles.

If you, as an informed or otherwise pharmacist, have any doubt about this matter please try it out for yourself and ask any GP, nurse, or Aged Care operator of your acquaintance, what they know of PCEHR.

The public are even more disconnected.

The public, as patients and taxpayers, do truly understand the burden of the huge cost in healthcare; yet have a contradictory view of what is good and bad. They believe that, in spite of all obstacles, on a whole we receive good care. The public are also certain that there is never enough money and what there is, is often, poorly used.

With this well established cynicism in place the need to ‘follow the money’ and not stuff up should be mission critical.

Keeping a few thousand insiders in a state of self appointed bliss will come to a sad end if the hundreds of thousands of coal face stakeholders and millions of patients and taxpayers see or even sense failure, like that in the UK.

There is at this time no informed mass demand for any e-health based change in Australia.

Therefore the first rule must be to keep the message simple and believable to sell a message that the eventual benefit is worth the national effort and the $400 million.

So far the PCEHR story is very much a blank page to the mass of any intended mass audience. This alone could hinder the ROI where money is spent on change and technologies, to and for people, who have no idea what is in store for them.

Any attempt to make big bang change, largely in the dark, will not work; it is the surest way to fail. So let’s hope that some of the $400 million is spent wisely on awareness and communication efforts to the T3 community.

In Australian healthcare interest groups we also have the tendency to purposefully design a perception of unique complexity into national projects. To always do this from the top down and often ignore the more tedious, boring and practical, small one at a time steps of a bottom up methodology. It is a cultural error. One that non-healthcare sectors inevitably do not do when making change happen effectively.

A thousand simple steps is a shorter journey than attempting huge implementation projects like that underway in the UK. This UK audit report illustrates that the big bang spending mindset delivers inglorious stuff ups which lead to a poor ROI outcome for the taxpayer.

Spending taxpayer’s money in this way is like giving alcohol to alcoholics, free reign on fees to bankers, speed cameras to public servants or unrestricted access to terrible web sites for pedophiles. Enough is never enough until the fan hits the doodo.

What is it we plan to do with the $400 million PCEHR investment between now and mid 2012 (let alone talking about the funding needed after 2012)?

Which pieces of paper will be removed as the catalyst for introducing a PCEHR hub as a national asset? One bit of paper or hundreds. One at a time, many at once or very few. Or, how many points of data capture are there where people obtain, store, retrieve and use shared information on paper that will need to be ‘changed’?

E-Prescriptions would be a radical place to start (I’m not kidding) as this touches more of the public, more often, than any other application – and is core patient record paperwork. But then so too are discharge summaries, referrals, tests, claims, payments and even the supply of what has been consumed, by and for, a patient.

Aside from an apology for a heavy pun, the best roll-out method for W1 and W2 will be to introduce change from the bottom up as viral phenomena. Get it started, get out of the way and then let harmonized evolution gain a natural momentum.

That said another factor that is still in play, takes me back to the analogy once used by a UK health sector writer: Comparing the huge infrastructure project in the 19thcentury to put sewer pipes under the streets of London and why that was relevant in a data sharing context.

I wrote a follow-up piece at the time for this newsletter (“The iffy smell of progress) that supported this example of sewer pipes and the information available in healthcare, with a dangerous lack of universal quality, to be pumped at the speed of light.

Message 1 being if the pipes and plumbing are a spaghetti mess of non-interoperable data networks, or databases and systems, then trouble awaits.

Message 2 is worse than interoperability. Unless the sources of core data are accurate and useful we risk spending money to merely pump crap. Or, to punch the point home, using the UK example, we must avoid spending a lot of money just to end up with a stinking mess.

Subtle? No, but eminently relevant

At the time I was saying, as was the original author of the ‘sewer’ opinion piece, we should leave the clinicians alone until the pipes, plumbing, standards and data sources (sewers of content) are cleaned up and are in place. Otherwise we are just interrupting their good work for no immediate purpose.

Today the question still remains: are the information sewers in our hospitals and wider healthcare community in good shape, or, even fit for purpose at all?

If not we will soon know as W1 and W2 sites and their taxpayer funded activities start to pump, exchange and re-use the existing content data.

Content data, let us not forget, starts with a clinical service person capturing data at the coal face. Regardless of how clean and accurate this data is, if the proposed changes do not save time, money and errors in the overall ambience of the data capture experience, then good data or not the project goals are very iffy indeed.

Who has been here before us?

Many pundits believe, as I do, that T1 and T2 health stakeholders rarely look for lessons-learnt of what works somewhere else. Think banking and insurance in terms of their technologies and procedural standards.

At no time did the broad financial sector introduce electronic transactions for online access and associated digital record keeping, along with personal identify protection, by selling the cleverness and complexity of the deep background technologies.

They just introduced simple changes at the point of interaction progressively and let mass demand gradually accept and then improve the value change proposition.

Simple steps tend to cost less in the long run. More importantly simple steps allow the people who are affected by significant change to stay in synch with the new world. No matter how much money is allocated it will fritter away and grow into black holes, unless people see and accept that the advertised benefits will be real and useful.

Finally a plug.

Let us do something very radical with the money go-round. Let us spend more than we ever have before on the local, usually smaller, IT and solution vendors.

The Australian ICT and health informatics vendors.

The vendors who have evolved and built products that work in Australia, for Australians. I suspect that the UK has blown a lot of dough converting very large systems that worked well in a vendor’s home country, to fit in with the Britishness of the NHS work practice model.

Let us get over this mindset we have that believes ‘big’ and foreign is always best. Where big and foreign inevitably translates to expensive.

More often than not the local solution is preferred by coalface practioners who sadly do not make the funding decisions and rarely get to say what they would prefer to use. If they were able to do so a whole level of costly change management hurt is removed in one simple stroke.

Our ‘big is safe’ cringe is something to behold when you think it through and look at the result of the spending and value evidence to date. If we follow the money spent since the announcement of ‘HealthConnect’, over the last decade, it shows much the same UK outcome, albeit at a slower, fragmented and in a more hidden manner.

Here we are and what should we do?

Wherever we are now, the question is where will be in June 2012 and beyond?

Maybe we could short circuit any risk of a penny dreadful result and engage the Auditor General now. Upfront, from the get-go, to be part of the ongoing T1 and T2 diligence effort.

In that way we will avoid any chance of it all ending badly – ending as badly as the UK model clearly shows could happen if someone does not - ‘follow the money’.

 

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