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Attentive readers of this publication will know that I have tried over the past 15 months or so to only comment on matters primarily to do with the boring, the tedious and the obvious. The supply chain and the latter being the Internet and/or e-anything.
Barcodes, POS, unique product identifiers, data capture and reticulation, central product repositories (cataloguing), leadership (largely lack of) and so forth.
Ho-hum.

Meanwhile the e-stuff remains fairly vague to the majority. Including the urgent need for access to broad band. Except that is of course for the fledging online e-pharmacy marketplace members.

The only interesting or different factor in the overall tedium of the e-supply chain subject is that, here in Australia, we are closer than most OECD countries to tie the supply chain to the clinical chain.
That is, MediConnect and eventually HealthConnect.
We truly are, and we should be grateful for that.

For those of us who follow the daily avalanche of worldwide Internet sourced health and pharmacy stories the contrast between them and us is pretty clear.
We are at the 'what will happen' while, say, the UK and the USA are at the 'what if it might happen' stage.

In all cases the overseas focus and engine of change is patient care, medical misadventure, along with the accompanying issues of privacy and safety.
In the US and UK the vocal drivers of the call to action were primarily the hospital pharmacy community. They have now been joined by the ICT sector - which clearly shows they can see the money in the coming rewriting of the rules and regulations, thereby opening up the procurement budgets.

Sadly, none see the mandatory need to get the boring and the tedious fixed first.
Lots of excitement about the technology, the privacy, the security, but all that is usually mentioned about product identifiers are the need for 'barcodes'.
Barcodes are useless carriers of junk unless the unique number is the single, reliable and universal numberplate for that consumer item.
Oh dear, it is so simple the elite can not see it!

Here at least the DoHA has in train, albeit at the speed of the train from Goulburn to Canberra, the MCCA central repository.
The fact that few seem to understand why they are implementing this should be of major concern.
And, the 'few' I refer to include the few major wholesalers we have left in the game here in Australia.

Just recently there were several relevant stores in the global virtual media.
President Bush's "State of the Union ' address set off an explosion or two when he made a direct and strong comment on EHR and the need for ICT health investment.
Incidentally Senator Hilary Clinton, the other one, gave a long and thoughtful speech on essentially these issues around the time of the President's speech.
Coincidentally of course.
Since then the FDA has announced a policy to have all medicines 'barcoded' by 2006.
The Yanks might be slow to move at times, but when they do, watch out.

Another is the ongoing gobsmacking project underway in the UK.
The $tens-of-billions being spent on health ICT.
The last story being that the supremo in charge of this project was visiting Bill Gates last weekend.
The purpose being to 'McGates' the UK health data exchange platforms.
Serious stuff.

Again, in all the zillion words washing around the Internet at warp speed regarding e-health the 'S" word gets only a passing mention.
Standards get the same sort of attention, in passing, as railway gauges did 150 years ago.
We all know why standards are important, but we are in too much haste to make sure the rails actually do meet.
The ICT industry has never concerned itself too much with 'sharing the customer's data' outside of self-interested silos.
So it is not surprising that they are not leading the push too ensure that standards are a mandatory part of the change platform.

Happily, as I have l already reported in these pages, here in Australia we do have the Standards Australia IT14 committee process in place.
And as such we have the ability to implement globally harmonised business and clinical e.health transaction documents sooner than any similar country.

So what?

Well, I could weaken my resolve and spend the time on a long article regarding a recent event -phoof - where a certain group, it was discovered, submitted a patent claiming ownership of these global developments in the use of the Internet to exchange information.
One wonders if they claimed the use of the fax machine, to exchange prescription data, as well.
The fact that this (2002 dated) misplaced claim was uncovered by others and not made public by the perpetrators says enough.
So let's move on.

Firstly, we have to mention the recent FTA negotiations between Canberra and Washington.
While the sugar deal went sour the overall result while bland and brotherly is undoubtedly good for all us. One matter however stood out. That was, of course, the PBS and the reported determination of the Americans to force up our "Mexican" prices for drugs to something closer to their Rolls Royce pricing heights.

Didn't happen, should not happen and lets hope it never happens.
And, in fact more than in hope, I believe that the light being shone on this cost to the US citizen, by both sides of politics, Bush and the lady Clinton, will lead to the heat coming off pressure on the PBS. Actually, many insiders feel that this is in part what the FTA attack is all about.
Not letting our success be used as a model in the USA, or elsewhere.
Sigh.
The suppliers still believe the world is flat and closed too.

What struck me about this story were not just us here in Oz but what is happening to our Canadian cousins.
Particularly the not so subtle change underway from a minority of American consumers, close to the border who routinely cross to purchase drugs, growing theoretically in the ability for any citizen to buy Canadian sourced product over the Internet.
Better than Mexico, Canadians after all, speak English.

Home shopping, catalogue shopping, home delivery and so on; is much more deeply ingrained in North America than in Australia.
All that snow and stuff.
So why is anyone surprised that forward looking pharmacists, in one community, see the inevitability of new ways to process and practice their professional skills with other communities?
Canadians have used and bought from the US based Sears and LL Bean catalogues for decades.
Why not the other way around?

The US corporate heavies, both suppliers and pharmacists, along presumably with independents and their wholesalers, did very little when the 'trade' was dependent on the motor car.
But hey, the car has been replaced by another travel medium and suddenly it's a serious threat to the status quo.

Change is always so.
Always effects everyone - some win, some lose.
Change continues to happen.
This was heard as a little tiny bang in Australia, but it should have been felt as more of a mighty kaabbooom.
Why?

Well let's take two reactions.
Firstly, it is reported, the US drug companies have decided to ban the supply of prescription medicine to these online, Canadian, pharmacies.
Note, not US, online pharmacies.
So, it is difficult to understand the reported claims of less 'care and safety' being the reason, rather than fewer 'dollars and cents'.
Remember the Canadians also have a FTA with the USA.
Their problem is that they also share a physical border.

And that is a moot point as the Internet, in part, shrinks the effect of borders and distance.
Given that the example of Amazon books, selling to anyone anywhere, aided and abetted by the efficiency of FedEx or Aust Post is now passé.

Secondly, there has been a reverse reaction.
The Governor of Massachusetts is so annoyed at the US companies retaliation that he intends to pass a law that will permit any citizen of the rebel state of Massachusetts to freely buy, online, from a online pharmacy (and I am surmising) pretty much anywhere.

While I wish to avoid the formal professional debate I must point out that the anti-Internet activists in the USA are akin to our mate Davey Crocket at the Alamo.
They are in trouble.
Global warming - water rises.
Global Internet use - change arising.
It's happening - bang, kaabbooom- the earth has moved and it will not stop changing for quite a while yet.

We are all aware of the Brisbane based company now well established, and pardon the pun, in this space.
Doing very well.
Filling a niche.
Love 'em or otherwise they are here.
They are not going away and they will continue to grow in new known and certainly still unknown ways.
Why?
Because the improvement in convenience offered will be seen by some Australians who will then embrace the Internet when buying pharmacy product.
And this excellent outfit is delivering or exceeding world's best practice.
So good luck to them.

Get used to it, because those Australians who feel they need another way will use online service providers when and if it works better for them than physically visiting a pharmacy - if they can.

Is it a geographical issue?
I think so.
Will it appeal to urban patient/customers?
Not as much.
What is a reasonable estimate of take-up?
At least 10% of the population in the short to mid term.
The longer-term picture depends on factors no one can truly predict.

A better or different example?
These online companies actually get 'orders' from Mongolia.

Upper Urdu Whereisit and many other places have people who can not get the range of OTC products, to be a little less controversial than discussing seriously scheduled items, that we enjoy.
If they have the money, the PC, the Internet and a delivery service, they will find those, like our online Brisbane boys and girls, who can meet demand, better than the local apothecary does.

Indonesia, as a cliché, is on our doorstep.
The middle class is huge and disadvantaged in access to many things - pharmacy range included. Meanwhile, shades of Canada, and things FTA, the Singapore Government did agree to raise drug prices when they signed their deal with the US.
While the Singaporeans are not disadvantaged by choice, perhaps they are, by price!
Some readers may know that almost all fresh milk sold in Singapore is sourced from Brisbane.
Why not haemorrhoid cream?

So, I'm sorry to renege on my resolve not to, but I have to have one further mention of the pitter-patter blatant patent blip.
The idea that a closed shop can be maintained for remuneration on middleware ideas and use, on the Internet, is just silly.

One the other hand, the loud bang in Canada should be felt more as an earth moving experience in Australia, than just hear a far off whisper that passed us by.

Still and all there are e-health information issues that are with us and will be with us for a long time. Some that are more routine for traditional pharmacy, some for online and other new method practitioners, and some that are for all concerned.
You may care to take a second and run through this unavoidable checklist:

1 EAN barcodes
Do we scan at POD and POS using the unique number printed on the packet?
Can we, will we or what?
If not, there not much need to read any further
2 MCCA
Do we understand the reason for and the planned use of a central national repository of unique medicine numbers for all prescribing and dispensary use?
No?
Better get a handle.
Ask your association representative perhaps.
They should know.
3 Communication links
Do I have, can I get or will I be able to use broad band or a similar high speed link to replace the (whatever number) of phone lines we now use for data transactions?
If not, please start to worry.
4 MediConnect
See 2 above. Take same advice
5 Software
a. are my applications IT14 standards complaint (HL7, XML, etc.).
That is, capable of exchanging documents with prescribing, hospital and HIC partners ?
b. can the systems function, online to the outside world, 24 hours a day, seven days a week, regardless of when the pharmacy is open and trading?
c. is our internal system all seamlessly interoperable?
Huh?
Is everything linked together internally so that all outgoing and incoming data can be managed without re-keying?
Your software vendor should be able to answer these fundamental questions as a matter of fact.
If not, they are in fact, not in the game.
6 Professional advice
Another fact is that all three professional pharmacy associations should be at the bleeding edge of this material.
As I have previously mentioned, the hospital siblings are hot on the clinical issues of patient admission, discharge summaries and notably reducing misadventures.
But, not so aware of the supply chain requirements that precedes e-health functionality.
As for the other two - well hmmm!
You ask 'em.

The kerfuffle late last year was the spectre of a well-known grocery chain trying to enter the pharmacy marketplace.
While it was, or still is more serious than many issues, this writer had views that were not generally mainstream.
Firstly, if I were acting for the enemy, the grocer, I would advise them to deliver to the ultimate customer what the ultimate customer wants.
If you don't get this, then sorry.
Alternatively, if I were retained for the good guys, my advice would be to get ahead of the e-health game, as soon, as far and as good as it is possible to be.
That is, see the checklist above.

Secondly, I don't believe the real threat, mid term at least, is the dreaded and very electronically efficient grocer having many front shop, back shop or beside shop pharmacy operations.

Look above at the subject earlier in this article.
Aside from the grocer, a foreign company with a mania for 'price' as a name presents a threat.
Perhaps more so.
My view is that both of them will be very aware of the entry opportunity online trading offers a new entrant.

The online pharmacy operators therefore could be under the more immediate threat.
The intended sacrificial victims of a Trojan horse bid.
Happily, in my opinion, they, the bad guys, could take a drubbing because the online pharmacy business I mentioned is doing it better, already, than most others around the world are and it is a niche market.

Anyway, if the two 'outsiders' were to go this way their information management systems are already fully e-health, online, Internet, compatible.
Not within a single business unit, not within a regional banner group, not within the sphere of a wholesalers state boundaries (product numbers and so forth) but nationally.
Same standards for numbers, patients, e-documents and the broadband pipes and plumbing big enough to handle any 'ultimate customer' data warehousing and e-records volume requirements.
Think about that for a moment.

If you and your enablers are not at least across these events then you need to feel the earth moving.
The Canadians have.