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The key landscape
issues will be the electronic use and the sharing of information
and knowledge to deliver improved patient care, reduce misadventures
and to track and trace both the money and clinical returns of
these activities.
Centred primarily
on implementing online electronic health records (EHR) for all
citizens.
With EHR as the hub, every other task and application will become
integrated spokes of this information utopia.
From a perspective
of the grocery threat it is worthwhile remembering that this massive
hub will require the seamless connectivity of shared data across
all providers of clinical care - that is, in the big picture it
will not be just a retail turf war matter.
It will be far more a health sector e.information reticulation
matter.
Consider the
benefits that will be realised when discharge summaries are accurately,
safely and usefully exchanged between doctors and pharmacists
in the community and doctors, pharmacists and nurses in hospitals.
Not the natural environment of the grocery sector is it?
At the same
time community pharmacy is a retail business that can adapt to
the emerging Internet influenced circumstances so as to remain
viable.
Given that a keen eye is kept on all the separate issues, the
future can be worth looking forward to with the optimism of the
half-full glass not the half-empty view.
A way to do
that is to recognise and focus on all the other 'Ps' that will
matter over the coming years. Although the competitive retail
debate is sure to continue it is not so clear whether the other
'P' issues are even on passionate or political radar.
Passions wane and politicians come and go but other matters will
be with us for decades.
Ignoring the
need to cope with a new and emerging, electronically shaped marketplace
will prove to be as threatening and as illusory as relying on
politicians to 'save you'.
Eventually
the time honoured outcome of the current competitive conflict
will see a compromise agreed. At that time the winners and the
losers will be determined by multiple and overlapping, practical
issues.
It is not
a trivial situation and as such it should not be left to chance,
or just passion, to reach the eventual resolutions. The next five
years will shape the scene for decades to come.
Until the yet unseen, unknown, next 'big-thing' supersedes the
Internet.
Look back
five or ten years and then try and see five, ten years down the
track, as one twenty-year block and snapshot of time.
What was nice and comfortable in 1995 will not be the same in
2005 and less so in 2015.
So what?
See it and react to it as progress rather than a burden.
To do otherwise is a certainly a choice, but one that history
tells us won't end happily.
Sooner than
later I feel the penny has to drop with our 'leaders' that the
nature of the Internet will greatly influence what pharmacy will
look like from 2005 and beyond.
Grocers are just one factor. Granted a serious one, but to focus
solely on them could let worse things come to pass.
In the meantime,
taking into account the following 'P' items can help to reinforce
the viability of the retail pharmacy community.
Be it as a stand-alone business or as a banner group operator.
The list you can consider is:
* People issues
* Process factors
* Practice habits
* Platforms (of ICT, broad band, standards, data and information
management)
* Professional pride and self interest
* Power of knowledge
* Pharmacy's profile
* Prescriptions
* Productivity and performance values
* PBS
* Product track and trace
* Partners
* Profits
* Payments
* POS/PC
* Patient records and privacy
* Policy
* Public interest
* Place
* Politics, and
* Passion
My personal
view is that the current sparring and the energy spent in the
media and elsewhere in point scoring may feel good, but is not
the answer.
To settle
the competitive threat in terms of win/win, lose/lose or win/lose
will be eventually resolved and measured in terms of who handles
the 'Ps' best.
The list is
in this descending order above - that is, starting with the most
important factor being 'people' and ending with the most wasteful
being 'passion'.
Naturally, the statistical model of human nature says a third
of you may agree, a third will argue passionately a differing
point of view, and the remaining third couldn't give a continental.
Doesn't matter
really how we see what is and what is not critical. Or in what
order you see them. Someone's 'most compelling' hot button is
someone else's fizzer.
The important thing is to know what these functions and attitudes
are and act accordingly.
The truly
central factor is the Internet. Particularly the ability of all
participants to engage in an interoperable manner. And it will
remain the one thing that will define major change in our society.
Of this there is no debate, no options, no compromise - save doing
something else in another enterprise or leisure activity.
The rules,
if that is the right description, have changed.
No matter where people choose to take a stand.
There is an invisible tsunami of information exchange functionality
washing over us that are certain to dominate events.
If that is
the case, and please fell free to challenge the prophesy, then
it is probably wise to face the future by maximising the opportunities
and minimising the threats in the context of integrated, electronic,
information management reticulation.
Take the juxtaposition
of three technologies that slowly crept into daily use over the
past decades.
Supermarkets
led and accelerated the use of POS and today most retailers operate
some form of electronic point of sale device.
Meanwhile, on one fine day, it just seemed that everyone had a
PDE, a tool also pioneered by the grocer cousins and rapidly adapted
by pharmacy.
Compare the functionality of a 1990 circa PDE with a PDA today.
Awesome difference in what is in the black box in your hand and
what it can do - particularly in realtime, online.
Yet, the dispensary
PC, which take-up also started slow and then suddenly became to
be in common use, is not the domain of other competitive entities
- it is uniquely a professional pharmacy technology tool.
By the way, today's PDAs can pretty much function as a desk top
PC and therefore is being used in USA hospitals as mobile dispensing
units.
What do all
these three technologies have in common?
Essentially they capture, save, store, transmit and receive data
- electronically managed information.
Today, and
moving forward, all this information is going to be exchanged
at warp speed over dedicated hubs rather than as a point-to-point,
very slow, phone line connection.
So what?
Go back to the 1970/80 period when none of these things were in
use.
Ah bliss - or was it oh blah?
Whatever,
the urge and need to 'know', and to know it better, sooner, faster,
cheaper and easier, ensured that technology flavoured process
and practice changes came to pass during this twenty five year
period.
The Internet
has brought about almost as much change, or the certainty and
picture of change, in as many months.
Question.
Right now, today, which retail community can best harness this
beast?
Yeah, scary
huh?
Passion alone as a weapon is not going to fly on this battlefield.
It will be a matter of getting, as best one can, all of your 'Ps'
in focus against the background of what can not be ignored or
owned.
The Internet.
Let's try,
briefly, to make some sense of this.
Remembering
that pharmacy is rightly and practically not one single personality.
Things that
matter for a staunch independent may differ from the interests
of a member of a banner group or certainly that of a hospital
pharmacist.
The latter are very important in the context of solidarity.
There will not, for example, be separate information management
disciplines and regimes based on who dispensed the prescription.
And, that
is what this all about.
Defending the exclusivity of the pharmacy turf.
Crude perhaps, but undeniably true.
In the confines
of reader's attention time and publication space, the following
brief comments may be cryptic for some readers. If that is the
case please do not hesitate to ask someone you trust and admire
for clarification - there is no such thing as a silly question
but the reverse is often not the case, so choose the guru carefully.
People
The single
and dominant driver of all change. Nothing, thankfully, happens
in a vacuum without a person guiding the effects and outcomes.
You have to
decide the importance of the following people to you and your
people in an emerging and changing e.enabled landscape.
- your customers
- your suppliers
- your competitors
- your professional and other partners
- your enablers, and
- most importantly the governors and the fee-payers, being:
- the people representing the people who will demand that the
Internet be used to benefit all people
Process and
practice
Usually go
together and centre on the obvious issues of what will be needed
to meet the electronic and technological impact in what you do,
how you do it, who you share the information with and how often
this takes place. For example barcoding will become a rule, not
an option.
Platforms
The juxtaposition
again of the combined public and private investment in reticulation
platforms will be the meeting ground for change. Linking the POS
and the PDE online with the supply side and the PC in the dispensary
with professional and governing/paying partners, is the future
hub and spoke of information electronic reticulation.
In the health
sector the drive to accomplish this national ICT platform will
be a significant effort.
Once accomplished there will be no where, no where, to hide.
Professional
pride and self interest
No need to
beat about the bush.
This is important and a fact of life. Perhaps the centre of the
whole debate and rightly so.
We can condense
the next few issues listed above in with this heading.
The power
of your knowledge and the combined collateral of this knowledge
is potent. Is this being put to the best use currently in the
competitive debate?
Perhaps it is and perhaps it is not.
Regardless,
the profile of pharmacy within the community, with it's partners
and governors needs to be moulded to best demonstrate the ability
to manage and own the knowledge of pharmacy and it's 'Ps"
in an electronic age. The longer you look in the rear view mirror
the greater the chance you won't see the truck as it rushes to
a head on crash.
Prescriptions
Also linked
to productivity and PBS issues.
Both issues that have a much more base instinct deep behind the
rhetoric of either a supplier spokesperson or a health sector
customer.
Because both rely on the true customer and their aspirations and
actions - the government.
It is no secret where governments, in all OECD countries, are
heading.
Online, online and online.
Meanwhile
we all still ask - what's in it for me!
Me, the pharmacist. Me the supplier and me the taxpayer. 'Me',
is a very important word.
The Internet is massively changing how many of us go about our
daily routines.
Usually because it delivers 'me' something better and more conveniently
than what happened before.
This will
shape the nature of competitive threats more than any other matter.
You have to believe that e.prescribing is how this will pan out.
Those that can will, and those that can't won't. Well, certainly
not on the same playing field.
Look at electronic
banking. Who would have ever thunk-it a few short years ago?
Product track
and trace
This has always
been an interest to the suppliers and their marketing people.
The fact that it currently happens crudely and imperfectly is
about to be impacted enormously by the use of the Internet. The
drive for this to happen will be compelling.
And this is
a coming fact, not a fuzzy opinion. As such, this will inevitably
change the fundamentals of product identification and your day
to day handling of products.
Bye bye PDE numbers, hullo EAN numbers.
Nothing surer
than night follows day. This will be the early step 101-compliance
requirement.
Are you ready?
But there
is more folks.
The evolution of MediConnect and HealthConnect will reinforce
the formal demand for the use of a unique identifier for each
and every product dispensed to a patient.
Otherwise how can there possibly be a national online EHR system?
In the context
of adopting change, adapting to change and benefiting from change
you could ask - 'who uses a EAN numbering regime exclusively today?'
You, your wholesaler and the enabler of your PC dispensing system?
No?
Does a competitive force reliably maintain and use EAN numbers?
Hmm?
Surely this
is clearly a problem that has to be faced and fixed. Regardless
of whether you are an independent, a banner team member or work
in a hospital. As I have stated in these electron-pages before,
if the present leadership stays appalling complacent on this single
product ID item then it will soon be time to panic. Or revolt.
Or perhaps just lay back and accept what happens.
Profits
Ah, the certain
attention getter.
But get this.
Your profits will be increasingly influenced by how you use the
POS/PC as they electronically record and transacted income along
with online claims for incoming payments for fees and such.
As well, the
outgoing payments, the banking and other transactions will be
electronically processed over the Internet.
Patient records
and privacy
For the first
time ever, EHR is now an established policy of the governing class.
No longer a gleam in the eye of departmental boffins.
Sooner or later it will happen.
Bit by bit, place by place the journey of a million steps will
gradually become the norm.
Online and/or
using smartcards the electronic patient history (EHR) application
is going to be a reality. Whatever we are told about the 'public
interest' the longer-term certainty is that taxes will stay and
personal e.health records will be established.
After all, they are part of the same equation - the benefit and
cost of healthcare that can be better delivered and contained
by electronic means.
Place
Sadly, or
realistically depending on your point of view, this is the current
impediment to massive and immediate, relatively speaking, change.
Willoughby
has the infrastructure in place - Warialda does not. We face a
situation of two classes of citizens or should we say taxpayers.
Those that can and those that can't be hooked up, to exchange
data at warp speed.
Politics
One "P'
step before the feel-good but rather useless emotion of passion.
And, is closely connected to the Place issue.
The important
issue is that politicians have control over the wherewithal to
universally implement broadband, or something similar, for all.
Until they do everything else is impeded to some or greater extent.
Unfortunately, too many in this club think 'doing-it' is a town
in Vietnam.
This is simply
a need for political leadership, maturity of actions and responsible
funding.
Rare treasures indeed.
The USA, UK
and notably the Canadian governments are showing more than a glimmer
of hope and example.
The USA is forming cross-sector healthcare leadership grouping
of health partners to implement common standards and broadband
communications infrastructure.
In the UK
the government has opened the purse strings in a spectacular fashion
to re-engineer their health sector ICT capability.
The size of the commitment is attracting wide and ever curious
attention.
Finally the
Canadians have seen the benefit of growing up.
Putting immature boy 'n girl stuff behind them and act as real
adults.
Using the overblown but under-used 'collaboration' word they have
put aside their fiefdoms, tribalism and proprietary structures.
Thereby changing the nature of data exchange into a common ability
to share information.
Radical and dangerous to be sure - no one ever got anywhere by
sharing eh?
Passion
And then we
have the passion. Save it for your personal relationships, your
footy team or your political bents. Any effort spent on the luxury
of passionate arguments, letters, meetings and posturing should
be (better) spent on benchmarking your beliefs, aspirations, capabilities,
weaknesses and the happiness to get out of bed and go to work,
against the list of the mighty 'Ps'.
To do otherwise
is more or less doing another thing that starts with 'p' and do
it into a strong wind.
None of the
scenario I am painting is one gigantic, crushing or horrifying,
tragedy.
No Sir and no Mam it is nothing of the sort.
Rather, you should see it as the need to take one small step at
a time.
Look, recognise, measure, act or ignore and move on.
All the while moving the day-to-day mindset from that of manual
transactions to that of achieving full online relationships.
One way to
get the mind in tune is to consider the fax to be an old friend
that today is as useful as a boat anchor in the desert.
Start with that premise and it is all down hill from there.
Once you have
this underway perhaps you can then throw in a bit of passion -
just for fun.
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