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"Once
upon a time, the government had a vast scrapyard in the middle
of the Australian desert.
The government said: 'Someone may steal from it at night.'
So it created a nightwatchman position and hired a person for
the job.
The
the government said:'How does the nightwatchman do his job without
instructions?"
So it created a planning department and hired two people, one
person to write the instructions and one person to do time studies.
Then the government said: 'How will we know the nightwatchman
is doing the tasks correctly?'
So it created a quality control department and hired two people;
one to do the studies and one to write the reports.
Then it said: 'How are these people going to get paid?'
So it hired a timekeeper and a payroll officer.
The question arose: 'Who will be accountable for all these people?"
An administrative officer, assistant administrative officer and
a legal secretary were hired.
But
then the government said: 'We have had this command in operation
for one year and we are $22,000 over budget, therefore we must
cut the overall cost.
So
it made the nightwatchman redundant."
Do
you see any parallels in the above parable?
We
have a Pharmaceutical Benefits Scheme that has faithfully followed
the above model, and one that is now to have grafted to it, the
Better Medication Management System (BMMS).
All that is now required is to calculate when and how pharmacists
will become redundant.
You cannot argue against the aims of the BMMS, which are to:
*
Have a centralised medication record with consumer access to their
own record.
* Reduce adverse drug events by allowing the addition of OTC and
complementary products, also detect "doctor shopping".
* Have the ability to check drug interactions and allergies using
desktop software applied to the centralised database.
The
outcome should be a reduction in the 80,000 people who are hospitalised
annually due to medication error, and the hospital admission bill
of an estimated $350 million.
It is also calculated that 32-69 percent of these errors are definitely
or possibly able to be prevented
The
initial participation in the scheme will be voluntary for consumers
and providers, and consumer consent is required for all interactions
with BMMS.
What
does this mean for pharmacists, and at what point do they become
redundant "nightwatchmen"?
Because the BMMS is an "opt-in" system, patient profiles
will have gaps in them, and may not be totally reliable. Patients
will also be given the power to suppress their own data.
It is probable that the government is going to rely on patients
to drive the process over time.
This could arise as a direct result from patients, in the past,
being denied access to their medical records.
Doctors used to claim that they owned the records, therefore patients
had no entitlement.
Rebellious feelings in patient ranks may just initiate the rush
to join the system, with those doctors/pharmacists who do no opt-in,
being left out in the cold, as patients patronise only the properly
anointed professionals.
My
past experience with systems and information flows tells me that
when someone tries to interpose along a flow of information, they
do so with the intent of expanding a power base.
This is done through the manipulation of results, by advancing,
retarding or restructuring the original flow of information.
And this is the worry for pharmacists and doctors.
When an "opt-in" patient visits their doctor and the
result of that visit is a prescription, the prescription will
be electronically lodged with the Health Insurance Commission
(HIC) initiating the first "leg" of the system. Simultaneously,
the doctor can view any previous medication history of the patient.
The patient then visits their chosen pharmacy, and the pharmacist
retrieves the prescription from the HIC database, and after dispensing,
lodges the dispensed details back to the HIC database.
This is all done online, but online systems are not without breakdown
problems.
If there are any anomalies with the doctor lodgment of the prescription,
details will not be released to the pharmacist.
In other words, you have lost actual or potential control of your
dispensing flows, which will certainly translate to management
and patient stress, particularly if a patient cannot access their
prescription appropriately through their nominated pharmacy.
Being the last point of contact, the patient will blame the pharmacist
for any "stuff-ups".
Online systems can be slow, and early tests of BMMS software by
doctors have confirmed this.
At peak times, multiple online access reduces speed further, and
document transfers may become painfully slow.
It
is obvious that pharmacists will have to redesign their work flows
and develop a different set of protocols to engage their patients.
This will cost.
For
the long term, the HIC now has total control of your dispensing,
by virtue of the fact that it has positioned itself between doctor
and pharmacist.
This is totally unnecessary, because a system exists to lodge
dispensed details with the HIC already.
It just needs to be refined for speed of lodgment.
The normal doctor to pharmacist flow, via the patient, does not
need to be disturbed at all.
If a doctor was given access to the HIC database of dispensed
details, prior to generating a prescription, it would contain
the same details as envisaged by the proposed BMMS system.
The HIC also knows that it will be a long term system, so all
items on the agenda will unfold slowly and will intensify according
to patient uptake.
As usual, government agendas do not always incorporate the best
interests of the participants, and you are left to guess what
adverse outcomes you have to plan for.
For
pharmacists, the inherent long term danger is government control
of "live" prescriptions (i.e. waiting to be dispensed).
The flow can be abruptly halted, or channeled to alternate dispensers,
manifesting as:
*
Hospital pharmacies
* Environments not owned by pharmacists e.g. a Woolworths environment,
should ownership rules be relaxed.
* Automated dispensing machines owned by the HIC and located in
your nearest Medicare office.
* An Internet pharmacy located anywhere.
The
options for a government wanting to increase its control are only
limited by imagination.
Ask yourself, "Is it necessary for a government to interpose
between doctor and pharmacist in the dispensing process?"
Test your answer.
There is only one conclusion, and that is "No!"
Ask yourself another question, "How close am I to being a
redundant nightwtachman if I cede control of my dispensing to
the HIC?"
Given
the fact that there is an equal distrust of the HIC by doctors
and that 90 percent of the information they require for patients
is immediately available from their own desktop, or via a phone
call to a pharmacist, it is only the global picture that is wanting
in the event a patient is traveling, or away from home and is
involved in some misadventure (causing hospitalisation).
A database can still be constructed using pharmacy claim data,
without interfering in doctor or pharmacist existing workflows.
All information flows to government should be after the event,
and under the control of the professional providing the service,
not the reverse.
Alarm
bells should be ringing now, and an alternative Internet system
should be developed between pharmacists and doctors. It should
be simple, cheap and reliable, while at the same time accelerating
the transfer of documents, rather than slowing them down.
It needs to be designed so that professionals are not forced to
"opt-in" by a patient, yet still provide the benefit
for the patient.
Just
a few recycled questions to finish up with:
"Do
you think the global costs of setting up the BMMS are really going
to be offset by the benefits?"
"Do
you think that the system will reduce your overheads?"
"Do you have a strategy to remain in an "opt-out"
situation, yet still provide equivalent benefit for a patient
i.e. so they can access a complete centralised database of their
personal details?"
"At what point on a timeline do you estimate that you will
become a redundant nightwatchman?"
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