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- Issue 81: April 2009
- Issue 80: March 2009
- Issue 79: February 2009
- Issue 78: December 2008
- Issue 77: November 2008
- Issue 76: October 2008
- Issue 75: September 2008
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- Issue 73: July 2008
- Issue 72: June 2008

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E-scripts For All... But we are Forgetting all About Iatrogenesis

Pat Gallagher
An IT Consultant Perspective

Issue 81: April 2009
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version

I want to talk about mistakes.
The mistakes we have made to date in doing very little about e-scripts, the mistakes we may now make regarding the delivery of e-enabled prescriptions and the mistakes e-health systems will minimise in healthcare delivery and outcomes.
These past two weeks have been a watershed for the (previous lack of) progress in matters to do with e-health and e-scripts in particular.
We now have two declared e-scripts systems out on the street toting for business with apparently two more in the wings.

I’m not going to name them all; they can do their own marketing.
But, as Pharmacists you will know that one consortium has close links to your professional association.
You are not on the ball if you do not know that these privately operated hubs are talking of charging, you, the pharmacist 25 cents a script, while billing the prescriber zip, nothing, nil and no-charge.
The one fact that stands out here is that prescriptions touch more Australians, more often, than any other clinical event.
Yet, up until now, almost nothing has stirred the juices of the policy makers, shakers, developers, implementors and even the crazy brave, to make something happen, other than a small pilot in the Northern Territory.

Not any longer.

We have gone from the sublime to the ridiculous and now have a war of sorts between competing service providers.
I have already taken sides between the black and the white, the good and the bad, the right and the wrong by supporting the one provider who professes to being basing their system on standards; while the other mob are not and will therefore be offering a proprietary system.

Standards must rule – OK!

Oh dearie me. This is an overwhelming opportunity for metaphors and cliches to come storming off a hundred keyboards in presenting pro, anti, indignant, lofty and any and all other flavours of opinion.
And that is what it will all boil down to – opinions.
Whereas we should be working towards sound public policy for any issue to do with transactions involving personal health care records.

For that is what a prescription is; part of a health record, part of the e-health landscape.
Not merely an opportunity to control commercial transactions that will theoretically earn private organisations 25 cents x 160 million, zillion or whatever number it is that we consume each year in prescriptions.
But hey, I do not blame the private operators one little bit.

How can anyone say, “how dare they”?
This has been a long time coming and time has run out.

We have had the bureaucrats and sundry experts, me included, talking about e-scripts since 1996 and e-health since 2000 and we have delivered absolutely sweet-flying-fish-all.
Whoever is currently employed in public sector decision making and policy setting roles should be ready to answer the question that will now be on everyone’s lips – ‘what now?'.
Because they are responsible for managing this sloppy situation and the collective vacillation preventing action has to stop.

For years and years we have had the platitudes about a brave new world of e-enabled patient care. And, that has just been the conferences.
Let us not forget to imagine the cost and verbosity of any number of reports. Reports that merely allow the leadership clique to pretend that ‘something’ is actually happening.
It is all just a pile of ink on paper – just expensive scene setting and as such, file fodder.

Not surprisingly then the private sector has said - “enough”; with an attitude that says - “these guys are never going to decide what to have for lunch” - “so let’s just rock and roll”.
And amen to that, because we now have change and traction on offer which will inevitably become unstoppable.
So now we are faced with competing (that’s good in a way) hubs that will eventually require harmonisation and interoperability to exchange prescription data.

However, you and I know that this is all ultimately controlled by legislation. It is called the PBS Scheme and the PBS is public property.
Which raise the delicious question of how will the receiving of 40 cents be squared away with paying 25 cents for each e-script?

At the end of the proverbial day this sudden watershed of private electronic prescription activity will require the public sector to get their act together.
To actually do what they are paid to do – ensure the e-script is part of a suite of interlocking clinical transactions that are ultimately part of an individual patient health record.
Oh happy days, guess what this will mean?
The private operators will ask for compensation or, some other form of remuneration, to justify their ‘cooperation’ for the greater good.

What is the greater good?

The policy makers and other experts are charged with working towards minimising iatrogensis by the use of health informatics, standards, technology systems and communication platforms.
Before you rush off, to check the dictionary, the various explanations for ‘iatrogensis’ variously refer to doctor error and disease related errors.
But errors abound in the healthcare system, and of course, we usually refer to them as medical misadventures.
Medical misadventures are caused by all sorts of people and situations, not just doctors.

One of the quotes that sums this up bluntly is - “we must avoid doing harm at the speed of light”.
That is, when manual service procedures are e-enabled the core benefit must be better patient care, not just processing speed.
Just sending a prescription electronically from a prescriber to a dispenser, across the street or via hub, is not the clever bit.
How it is done is not as crucial as what is done holistically that improves health outcomes.

A free-for-all competitive stoush is now underway for a prize that is ill-defined and will remain so until or when the public-policy platform is enforced.
Are the private operators acting out a plot that will only result in making their own iatrogensis? Perhaps they are taking a risk but they obviously think the risk has merit.

And that is the Granddaddy question and issue; what is the risk of iatrogensis events to you, me, her and him from all of this privately driven e-prescription activity?
Moreover if we follow the money trail, all treasure chests and troughs lead back to government agencies spending taxpayer money to deliver to us better health care services.

Australia cannot make a fatal (pardon the pun) mistake here.

Or, will we?

Which leaves us with the real and only series of questions of how is this going to be fixed, who is going to do it and when?

Opinions aside, this surge of market activity by the private sector has at least ensured the we no longer have to answer the ‘if’ question.


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