SEPTEMBER,Edition # 33, 2001

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Editor' Note:
Terry Irvine is a pharmacist of many years experience and one of the first of our profession to fully embrace, and understand, computers and related information technology. He appears not to have lost his idealism over the years and retains a positive vision for his chosen profession of pharmacy. In his first article he outlines some of the "future shock" that may occur in pharmacy sometime down the track.
Then again, it may not.
The idea is to stimulate some thought and debate on the subject and embrace change...not fear it.
As such, Terry is a very welcome contributor to this newsletter, for his presentation of ideas will genuinely be "out of the square", an inherent quality which all the Computachem writers seem to share.
Those of us who aspire to have a vision, are often moved by inspired thoughts of others.
Terry is no exception, and shares with us quotations from a publication containing some inspirational material, which has attracted his intense interest, entitled:

The Cluetrain Manifesto: The End of Business as Usual
(Check out the link)

"Online Markets... Networked markets are beginning to self-organize faster than the companies that have traditionally served them. Thanks to the web, markets are becoming better informed, smarter, and more demanding of qualities missing from most business organizations."

"...People of Earth The sky is open to the stars. Clouds roll over us night and day. Oceans rise and fall. Whatever you may have heard, this is our world, our place to be. Whatever you've been told, our flags fly free. Our heart goes on forever. People of Earth, remember."

(Copyright © 1999 Levine, Locke, Searls & Weinberger)

The book is a philosophical collection of ideas on the Internet and marketing.
He also points to the first chapter, by Christopher Locke, entitled:
The Internet Apocalypso
which is found by following the above link, and is excerpted below with slight modification by Terry (in italics).

you set my desire...I trip through your wires (U2) Premature Burial We die. You will never hear those words spoken in a television ad. Yet this central fact of human existence colors our world and how we perceive ourselves within it. "Life is too short," we say, and it is. Too short for office politics, for busywork and pointless paper chases, complying with HIC edicts,for jumping through hoops and covering our asses, for trying to please, to not offend, for constantly struggling to achieve some ever-receding definition of success. Too short as well for worrying whether we bought the right suit, the right breakfast cereal, the right laptop computer, the right brand of underarm deodorant. For worrying if we have the shop stock at the right price, if we have chosen the right style and material for the staff uniforms. Life is too short because we die. Alone with ourselves, we sometimes stop to wonder what's important, really. Our kids, our friends, our lovers, our losses? Things change and change is often painful. People get "downsized," move away, the old neighborhood isn't what it used to be. Children get sick, get better, get bored, get on our nerves. They grow up hearing news of a world more frightening than anything in ancient fairy tales. The wicked witch won't really push you into the oven, honey, but watch out for AK-47s at recess. Amazingly, we learn to live with it. Human beings are incredibly resilient. We know it's all temporary, that we can't freeze the good times or hold back the bad. We roll with the punches, regroup, rebuild, pick up the pieces, take another shot. We come to understand that life is just like that. And this seemingly simple understanding is the seed of a profound wisdom. It is also the source of a deep hunger that pervades modern life - a longing for something entirely different from the reality reinforced by everyday experience. We long for more connection between what we do for a living and what we genuinely care about, for work that's more than clock-watching drudgery. We long for release from anonymity, to be seen as who we feel ourselves to be rather than as the sum of abstract metrics and parameters. We long to be part of a world that makes sense rather than accept the accidental alienation imposed by market forces too large to grasp, to even contemplate. Testing, Testing... But what's this got to do with the Internet? A lot. The Net grew like a weed between the cracks in the monolithic steel-and-glass empire of traditional commerce. It was technically obscure, impenetrable, populated by geeks and wizards, loners, misfits. When I started using the Internet, nobody gave a damn about it outside of a few big universities and the military-industrial complex they served. In fact, if you were outside that favored circle, you couldn't even log on. The idea that the Internet would someday constitute the world's largest marketplace would have been laughable if anyone was entertaining such delusions back then. I began entertaining them publicly in 1992 and the laughter was long and loud. The Net grew and prospered largely because it was ignored. It worked by different rules than the rules of business. Market penetration wasn't interesting because there was no market - unless it was a market for new ideas. The Net was built by people who said things like: What if we try this? Nope. What if we try that? Nope. What if we try this other thing? Well, hot damn! Look at that!

The following article has been stimulated by reading the first chapter of :
The Cluetrain Manifesto: The End of Business as Usual
( Copyright © 1999 Levine, Locke, Searls & Weinberger)

The first chapter is the part that can be read for free on Internet - it is so stimulating that I am tempted to buy the entire publication - I must look to see who sells it in Australia.
I know Amazon do in the US but the freight charges from the US are awesome, and the exchange rate is still poor.
Some modified paragraphs precede this glimpse into the future.

By way of personal introduction.
Many years ago I became enamored by computers, an affair that culminated in us acquiring what was thought to be the first computer in pharmacy - at a cost of $120,000 or the price of 20 Volvos at the time (really powerful computers can now be purchased for less than one twentieth of the current price of Volvos - there must be a message there somewhere).
Later we became IBM PC Dealers, I went on to graduate with a Diploma in Applied Science (Computing) from the Charles Sturt University in Wagga Wagga, in 1992, and our family has continued with the love affair with computers - eldest son Rod, although a pharmacist, is some sort of architect with Compaq Computers, based in Adelaide he has been to New Zealand three time in the last few months and often travels to the Eastern Capitals.
One of the twins, Bradley, is with the NT Government's computer section and was responsible for the recent outsourcing of IT. The other twin, Andrew, is a partner in what is probably on of the most computerized hotels in country Australia , at Wagga Wagga.
Since leaving Darwin, most of my work has involved computers and pharmacy to some extent, currently I am logged into Internet for many hours each day, surfing between prescriptions.
Way back in the early days when I became aware of what computers could do I wrote an article that was published in the AJP where I explored the possible actions of sick people and their diagnosis.
Since then Internet has come along and provides even more facilities for people to interact with computer systems, all over the world, and stimulates me to flights of fancy with regard to what could be possible, and what effect it could have on pharmacy as we know it today.
When I was first introduced to Internet by an enthusiastic lecturer at CSU I was underwhelmed by it - not much information available, and very slow modems - it seemed suitable for academics, but I did not want to become one of them.
Of course since then the explosion of information available on the net has been fantastic, and the availability of fast modems, and cable connection, as well as Windows type presentations has meant I am forever being gobsmacked by what I can find - sometimes I am frustrated because I cannot find what I am looking for but his is more because I do not know how to ask the question more than the information not existing.
So let us consider how the administration of health care may be performed in a few years time.
The patient wakes feeling unwell, and without any idea of why.
Stumbles to the computer, picks up the laptop from beside the bed, or tunes into the interactive digital TV. From the links already set up on the home page of the prospective patient - whom we will call the PP - initial diagnosis of illness is selected.
A series of questions are then asked and the PP points and clicks onto the appropriate answers. The initial diagnosis then suggests a series of tests to be performed, searches its data base to establish the most appropriate appointment time at the testing facility, advises the test required, and advises the PP of samples that need to be taken to the test.
The test results are fed back into the PP's data base and further diagnosis is performed.
The next step could well be an appointment at a medical facility, be it general practitioner, specialist, or hospital.
Of course the initial diagnosis, or subsequent tests, may have detected a condition that required immediate hospitalization, in which case the ambulance would be automatically called.
However, assume the PP can remain ambulatory, and the practitioner prescribes treatment. A number of scenarios could result, none of which would necessarily involve a pharmacist, and would depend on what technology had been adopted in the meantime.
The smart card could be universally adopted, which would mean the prescription details would be written onto the PP's card by the prescribers computer, the card taken to the nearest prescription medicine dispensing unit where it would be inserted in the machine and the medicine labeled and dispensed.
The precursors of medicine dispensing units (MDUs) already exist.
They dispense money, cigarettes, soft drinks, coffee and tea, and confectionery, and condoms, and various other products.
Medicine dispensers would be scaled up, and kept secure in much the same way that money in ATMs is kept secure. There would be no risk of money being stolen from the MDUs as the financial transactions would be automatic between the MDU and the patient's bank.
Alternatively, the prescriber could send the medicine requirements from computer to MDU. It may be appropriate for the MDU's to be situated in prescriber's rooms, or a building that houses multiple prescribers, or in Service Stations, or Hotels, anywhere where people tend to congregate and there are at least some people in attendance to increase the security of the MDU.
On second thoughts the Service Stations of the future may only have automated pumps, these exist now but I think the service stations turn the links off when their shop sales are low for the day.
Of course the hotels may be automated too, with drinks only being dispensed to people who can establish they are below the limit or can prove they have transport home if they are over.
Details of the medicines dispensed would be sent to the patient's web pages, and appropriate links would automatically be established.
When the patient returns home and turns to their home (Internet) they would be advised of the new information links that had been established, and encouraged to visit those sites.
This is much the same as the screen that greets you in some hotel rooms now, except that rather than inviting you to look at the inhouse movies you could be treated to broadcasts which acquaint you with information on your illness.
Printed information would be available of course, on the Internet, with hot links to further explain terminology with which the patient is unfamiliar.
So where does the pharmacist fit into these scenes?
Already in the UK enrolments in Pharmacy schools are down, even though they are proposing the establishment of two new schools in England.
Could it be that the word is getting out that pharmacy is not too exciting, neither true professional nor trained retail trader?
The concept of forward dispensing is honorable, but how much really goes on?
Is it only a way to dispense while sitting down, instead of standing in front of a computer?
My impression of prescription dispensing is that the majority of prescriptions are for continuing therapy for stabilized patients, who from their own experience with the medication are more familiar with it than many pharmacists.
Could we see the emergence of a select few, really well trained, motivated pharmacists, skilled in drug knowledge and communication who, for a fee, discuss the very complicated therapeutic regimes with the prescriber and the patient, and/or patient's carer?
Perhaps the role for many pharmacists could be in the monitoring of patients' conditions, by sampling blood and other fluids, assessing the results and then modifying the dose in response to the findings.
Dispensing continuing therapy without the need for medical consultations could be a consequence of this action.
However, it is conceivable that medical technicians could perform the tests at less cost than using pharmacists.
I have no idea how these scenarios could be adapted to the hospital setting.
Could we see automated dispensing at ward level?
Are pharmacists better rewarded professionally but not financially in hospitals?
Are they better recognized as peers by medical practitioners?
If this is so, how does this relationship suffer when doctors leave hospitals and pharmacists practice in "open shop"?
Comments are welcome.
Ends

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