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The transmission of prescriptions and other electronic health records is coming closer to a reality, as a number of systems begin to evolve globally, for this purpose.
Australia is well advanced in developing such a system, which may prove to be more efficient than some of its counterparts being developed in other parts of the world, such as the UK
The British Journal of Pharmacy, in a recent article, states that the Department of Health wants to see three of its pilot studies in England, completed by November 2002, so that each of the systems can be fully assessed by government by April 2003.
British GPs are to be in a position to transmit electronic prescriptions also by April 2003.

Each of the pilot studies in question have been funded privately by different consortia that have formed around three separate and distinct systems.
It is not clear what is going to happen after November 2002 and whether the government is going to support one specific scheme and create a national model, or take the best aspects of all the systems being trialed, and create a hybrid to be developed as a national model.
This approach does not seem fair to the participants, for there is a significant private investment in each system, and each will lobby to have their own system retained.
The end result is that there could be three (or more) models from which all pharmacists can select from, each of which would need to harmonise with a central government processing and storage system.

There is not a great deal of difference in this approach and that taken by Australian software developers of dispensing software. Competing software suppliers have created a range of innovative options built into various systems, and Australian pharmacists have had a reasonable choice as to what system they would embrace. They have even been able to influence the course of software development by constantly communicating their needs to the various companies, influencing their product responses.

The result has been that Australia has some of the best dispense software in the world, which has been confirmed by a number of our writers, who have worked in overseas pharmacies over the past three years.
The Australian government was initially slow to respond to pharmacy IT developments, but now it seems to want to move into a more controlling position, through the Better Medication Management System (BMMS) and the Health Connect project.
In so doing, it has committed itself to millions of dollars of taxpayer money to create one national, but centralised system.
This means that Australian pharmacists will not have to fund major software development, but they will have to alter their hardware capacity and work flows to adjust to a centralised system.
There will be a cost in adjusting to this process, and a further downside as the government continues to develop the system to service its agenda, rather than the needs of a pharmacist's customers/patients.
There will still be a need for pharmacists to develop and fund systems at the "micro" level to cater for local customer/patient needs.

One i2P writer commented in the August 2002 edition on the BMMS, and the fact that one major process is to be immediately disturbed i.e. a doctor has to generate a prescription and forward it first to the Health Insurance Commission (HIC) for processing and later download to a pharmacist.
This is a direct interruption of the traditional doctor-pharmacist relationship that has existed for centuries, and appears to have the potential for future government manipulation.
This single process will eventually cost pharmacists a measure of independence, and will add to overheads.

The three pilot systems in the U.K are known as Flexiscript, Pharmacy2U and Transcript.

Flexiscript is currently linking eight pharmacies and eight GP surgeries, and is owned by a consortium consisting of Boots The Chemists, Unichem, National Co-operative Chemists, SchlumbergerSema, Microsoft and Cable and Wireless. The consortium aims to have its pilot scheme operating in 28 pharmacies and 22 GP surgeries by the end of 2002.
The system has currently enrolled 3000 patients and transmits prescriptions electronically at the request of the patient. The system is being offered to all pharmacies operating in the Peterborough area (which is the physical location of the trial) and participating pharmacies are then linked via an ISDN line.

The system works by the GP sending an electronic prescription to a central computer, while simultaneously giving the patient a paper copy of the prescription with a bar-code and serial number printed on it.
The patient takes the prescription to their pharmacist for dispensing.
If the pharmacist is a participating pharmacist, all that is required is that the bar-code be scanned and the serial number entered, to retrieve the details electronically.
Non participating pharmacists have to enter prescription details manually as in the past.
Both the GP and the pharmacy are linked to the British equivalent of the HIC, but unlike the proposed BMMS project envisaged in Australia, details are transmitted after dispensing.
The system also allows for messages to be tagged to the prescription by the GP.
Flexiscript is claimed to free up pharmacist time, because it can be totally delegated to dispensary technicians "in-house". Pharmacists are only required at the end of the process to interface with patients and intervene where potential errors may have arisen.

It takes 20 minutes for the U.K health authority (PPA) to acknowledge receipt of the electronic details, but to quote one member of the consortium "sending information to the PPA directly does not mean that you get paid earlier than with the paper versions".

Pharmacy2U is another pilot running in the Leeds/Stockport areas involving 11 GP surgeries and seven pharmacies currently. Six of the pharmacies are owned by Co-op Health Care and the pharmacy in Leeds operates as an Internet pharmacy.
Prescriptions are electronically transmitted by GPs to the Pharmacy2U central computer in Leeds.
Like Flexiscript, the details are received into the various dispensing computers electronically and dispensed. A paper copy is also generated, which is used as a picking slip and doubles up as a repeat reminder for the patient.
Once picked and checked, prescriptions are dispatched by registered mail.
Pharmacy2U has incorporated its own, previously developed, administration software, which alerts as to which patients may require repeat prescriptions (based on last date of dispensing). Pharmacists contact patients by stated preference (home or work phone, mobile phone or e-mail) to verify repeat prescription orders or to advise the need for GP review. Patients can also enter the pharmacy website and order prescriptions online.
Operators of the system report that the "drop out" rate is extremely low, as patients quickly perceive the benefits and time saving involved.

Transcript is the third pilot system and is a consortium of PharMed, AAH Pharmaceuticals and BT.
It is the smallest of the pilots and currently involves one pharmacy and one GP surgery.
The pilot is being run in East Hampshire, and the consortium operator has reported extreme difficulty in establishing the project, which appears to have been slowed down due to average patient age and associated polypharmacy.
Despite the lag in time compared to the other two pilots, Transcript is about to go live in five pharmacies and seven GP surgeries, with 22 pharmacies and 16 surgeries to be involved in the final project.
The Transcript project works on a bar-code printed on a paper prescription issued by the GP.
The bar-code is scanned in the pharmacy, allowing all details to be entered electronically.
This is seen as an interim solution, and Transcript is also moving towards receipt of digitally signed prescriptions from GPs automatically, via the Internet.
Transcript appears to be working on a range of alternatives rather than "one size fits all".
It could be an interesting system to follow for Australian pharmacists, for the consortium seems to be moving with a bit more sensitivity than the other projects, perhaps because of patient average age and complexity.

While the British government wants all the pilot schemes completed before the end of 2002, what happens after this date is unclear. While conceding it would be inappropriate to withdraw services from the pilot services delivering benefit, they want to see a "clearly defined and managed process for implementing ETP nationally". It appears that it will settle on a hybrid format based on the best of what the pilots have to offer, but no decisions have been made as to whether existing system upgrades will be funded or as to how the remainder of community pharmacies are to be connected.
However, they state they are sticking to their original targets of having 50 percent of prescriptions sent electronically by 2005, and "full clinician and patient functionality" by December 2007.
It is expected that paper based prescriptions will be needed for some time to come.

The general consensus so far is that Pharmacy2U has a clear lead and is handling prescription volumes with ease. Patients seem to like the Internet version, and value-adding with information is enabled quickly and with low cost. Patients are empowered to interact with the site and order their requirements from the comfort of their home-not just prescriptions but all general products as well.
Flexiscript has been voted a clear second and probably fits the existing paper-based model more closely.
Transcript gives the impression of being stalled, because of slow progress, but there could be some aspects that may fit into the final program, mainly because of its focus on elderly and complex patients.

Of all the UK projects, Flexiscript seems to follow the proposed model to be used by the Australian government, with the difference being that they will actively be participating in the management. The central computer facility that is in private hands in the UK model, will be replaced with government control.
However, unlike the Australian proposed model, the UK systems do not operate with a universal product code.
To not have decided on this basic aspect of a system means expensive reprogramming down the track, irrespective of which model is finally utilised.
Most Australian software developers have been holding back on their own systems because, until recently, the Australian government had not decided on its coding system. It will, however, use the EAN system, which will reach back into all areas of National Health, including the product numbers of the Pharmaceutical Benefits List.

Whatever the outcome of the British or Australian systems, the writing is clearly on the wall.
If you are to retain any sort of progressive and competitive lead in the pharmacy market, you must be e-commerce enabled.
This does not mean that you have to be a Pharmacy Direct clone, but you will lose a pricing and service advantage if you do not have an e-commerce division to deliver benefit to your customers/patients.
And there is more to e-commerce than just retailing.
I.T systems integration involves savings on "back end" overheads.
The prescription reminder service operated by pharmacy2U, while being electronically driven, is an integrated process involving "live" pharmacists, and is only one of the many hidden systems held by that organisation.
At least one Australian Internet pharmacy is providing a similar system.

Competition of this type is well under way in organisations outside of pharmacy e.g. Woolworths.
I.T systems now form part of a pricing system, previously commented on in this publication (the EDLP system).
Unless pharmacists learn and understand these new processes, they will forever be left behind in the competitive stakes.
With BMMS now into a more tangible phase, we are about to see changes that may cause discomfort to some, but challenge to others.
Where do you sit?