Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Pharmacy is in the trial stage of entering into a range of new government driven health IT systems, the first entrants being HealthConnect and MediConnect.
Of course there are other types of government systems already up and running that may be used casually by pharmacists, within their business or in their private capacity e.g. lodgment of company returns, various supply chain systems, claim lodgment with the Health Insurance Commission (HIC) etc.
The new health systems are going to generate a large number of electronic records and the need to keep track of them, store them and retrieve them in an efficient manner is looming as a major issue.
In the public sector, right at this moment, a major headache has emerged in that the management of electronic records has not kept pace with the generation of electronic records.
Nor has the solution to the problem of record management kept pace with the introduction of new systems.

Pharmacy is about to engage in new systems such as MediConnect at a time when it has no solution for managing major electronic record collections, concurrent with government agencies driving the new systems having similar problems.
The ultimate flow-on effect in pharmacy will initially be labour intensive and expensive.

The recording of information published on and removed from web sites, plus e-mail integration, are just two problems generating headaches in the field of records management.
Record keeping policies are being developed separately by each of the state governments.
The NSW government is campaigning for all of its online business to be documented.

In the business arena, there have already been legal disputes lost because of poor record keeping, and there is a need for compliance with ISO standards. The need for solutions in electronic record keeping is becoming crucial, and the inclusion of e-mail in all corporate records is starting to loom as a major cultural shift for governments and their agencies.

Pharmacy will be caught up intimately with this cultural shift, so those pharmacists complaining about the problems inherent in QCCP accreditation look as though they will have one more addition to their list of manuals and procedures.
John Skyllas, writer for i2P commented in his last article about QCCP:

"It's as if the people who have designed the program think that we have little else to occupy our time. Business plans, Staff appraisals, Incident reports, Performance benchmarking, Privacy Acts, Occupational Health and Safety reports, Pharmacy Appearance reports, the list goes on and on.
If they expect us to write endless reports and document everything we do, then how much time does this leave us to spend doing the most important thing in our pharmacies, serving our customers."

And he does have a point.

However, the big question arising from the above issues is "Who pays?".
Will you be keeping these records for yourself (for the benefit of customers/patients), or will they become very elegant recording systems for the various government agencies?
Are you developing protocols for "the blowing of the nose", as reported by the British pharmacist turned barrister Grahame Southall-Edwards (follow this link), which ultimately ends up being a means of manipulation and control by government and global interests?
The $7500 paid by government to Australian pharmacists as a once up payment to assist in QCCP accreditation is a pittance, and pharmacy negotiators for the next Guild/Government agreement should be setting the groundwork for government to pay for all these ongoing and expanding processes.
This burden of cost for record keeping and the raising of "standards" should not fall solely on pharmacists.
If Australian consumers are demanding higher levels of accreditation with their health system, then they must be prepared to collectively pay for it through the taxation system.
Payment needs to be determined in terms of software investment, supporting hardware, and the physical time for staff to complete all these records.

External evaluation should not be so much as to how well a pharmacist is compliant in QCCP procedures, but in what these procedures have achieved and how have they been applied for the betterment of patient health.
This is the real test between mindlessness, keeping and maintaining endless records for no good purpose, and that of good management with direct patient benefit.
What will be the benchmarks to measure good patient outcomes, including cost?

IT staff in many settings, both government and private enterprise are busily designing databases for document storage and specific applications, particularly in the area of document retrieval.
The NSW government has endorsed a software product called Recfind to register and file documents, and they are also experimenting with software to automatically capture e-mail into record management systems directly.
The challenge lies in developing databases with custom-built applications, which are not just cumbersome add-ons to existing systems, but are designed specifically as a solution for each individual problem.

Before pharmacists begin to jump in ahead of the problems noted above, they should seek the advice of a good IT consultant, and have that consultant specify a system that is simple and effective.
It is better to look at the problem through its individual components and develop software that is modular, rather than trying to go for the "big picture" all at once.
It is easier and cheaper to alter or enhance a small module, as the problem of record management is experienced, and individual perception is enhanced.

What is really emerging for pharmacy is the need for an in-house IT consultant to manage installations and processes to the level of their competence, and then engage specialist consultants to give direction and skills.

Logically, following the above reasoning, is that it is cheaper for one pharmacy in a given catchment to undergo these processes, rather than multiple pharmacies at a much greater cost.
This argues for mergers and the hastening of corporate structures to accommodate such processes, an issue that has been raised by many writers within i2P over the years, and one that was originally identified over three years ago in the Wilkinson Review.

The recently released document prepared by the National Pharmacy Workforce Reference Group (NPWRG) hints at the above process under the heading of Pharmacy Rationalisation, stating:

"that further amalgamation of community pharmacies, leading to the creation of larger pharmacies, would provide a better platform for the delivery of cognitive services, although it was noted that, in the past, closures meant some pharmacists leaving the profession altogether. Members of the NPWRG have noted that some operators make a commercial decision to open for long trading hours for competitive reasons, not always in response to consumer demand."

It does not seem to have struck the consciousness of the members of the NPWRG that a different culture is inherent in the concept of a corporate pharmacy structure.

An old style amalgamation:

* Involves forming a partnership, which is an inefficient business structure for most participants.
* Creates legal responsibilities, particularly for silent and dormant partners.
* Is an unattractive proposition resulting in the possible early retirement of pharmacists.
* Generally involves a third party (wholesaler) to underwrite the transaction.

A new style merger:

* Involves forming a company, which is a more efficient business structure.
* Concentrates legal responsibilities within the directors and managers of the company.
* Allows shareholders to avoid the legal responsibilities of a partner.
* Allows trading or exchanges of shares which virtually eliminates third party (wholesaler) involvement to underwrite the process.
* Creates new management and professional opportunities, because of the increased scale of the enterprise.
* Encourages pharmacists (old and new) to embrace the new opportunities, which results in the retention of pharmacists, thus reducing the current rate of pharmacist demand.

Pharmacy leaders should be out there now promoting a philosophy built around a new style corporate merger which actively encourages pharmacist retention, career diversification, all staff involvement (including support staff), and all built on a platform of a new beginning and an increase in opportunity.

With corporatisation there would be an initial loss in the total number of pharmacies.
Provided there were no restrictions on the number or location of pharmacies that could be owned within that corporate structure, there would be a progressive (but small) eventual increase, matching consumer demand.
The big plus is that the new corporate structures would satisfy pharmacist ambitions, particularly in the ability to pay for cognitive services, and an improved lifestyle would emerge

With regard to the comment by the NPWRG relating to extended hours openings being for competitive reasons rather than for consumer demand, it should be noted that all major retailers have opted for extended hours as a weapon to gain market share, generally at the expense of small business, which is unable to sustain the human and financial cost.
In my mind, a pharmacy that could match the trading hours of a major supermarket would be matching consumer demand, because consumers are already supporting the concept.

We are certainly living in challenging times and we have no choice but to adapt.
The threat of terrorism on the news each day and the problems inherent in trying to be successful in your chosen profession, are compounding to create stress levels possibly not encountered by pharmacists of previous generations. By concentrating the various problems and sharing them around, may just give you that extra "space" to claim back your family, and your weekend, once more.