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Monday, July 06, 2009

Minister Roxon is About To Have Australian e-Prescribing Slip Out of Proper Control.

A day or so ago eRx released its most recent newsletter.

The Newsletter can be found here:

http://www.guild.org.au/uploadedfiles/National/Public/Guild_Initiatives/eRx%20June%20News.pdf

The key bits of information contained in the 2 page newsletter are:

1. NEWS FLASH - 150,000 scripts transmitted since launch in April, and more than 1500 contracted pharmacies and GPs to date.

2. COMING SOON - From July, eRx Script Exchange will also provide a more efficient process for managing new and owing prescriptions, with the owing script and new script request functions. This will provide messaging capability between GPs and Pharmacies of new or owing scripts required, therefore removing the need for sending requests by fax or telephone.

3 PARTNERS LIST – The whole of page 2 is a collection of logos from all sorts of commercial parties who are involved with the plan.

It is interesting to note that there are only 2 prescribing systems currently listed as partners and that Medical Director and Genie are not.

If you are curious to know what is being done visit here:

http://www.erx.com.au/Demos/eRxInAction.aspx

In its present form I am not at all happy with the way this is evolving – recognising, of course, that this would only be happening if there was not substantial frustration with the progress NEHTA and DoHA have made in the e-Prescribing space.

I have written on the plan and a proposed competitor here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-wars-break-out-in.html

This also provides a backwards link to another set of comments specifically on eRx.

This is here:

http://aushealthit.blogspot.com/2009/03/e-prescribing-comes-around-again-in.html

Why is control being lost? For a start the DoHA commissioned consultancy to advise Government how to proceed is not due to report until 34 weeks after somewhere in May, 2009 when a contract to do the work should have been signed. This simply means all this is happening in the total absence of any Government leadership and direction – never a good thing until well into 2010. Government is meant to provide frameworks and guidance to assist things like e-Health develop in ways that are valuable for the community – but right now they are just absent the field.

We also have eRx saying they are not actually planning to use the relevant Australian Standards (SNOMED CT etc) See the FAQ:

“What messaging standards will eRx adopt?

eRx will adopt messaging standards when possible. eRx will however not let standards, or a lack of standards, further slow the implementation of this vital piece of the e-health infrastructure.”

Note a competitor Medisecure is planning a standards based approach. See here:

http://www.medisecure.com.au/index.html

This then brings up the question of, if this actually goes ahead and develops substantial scale, just what relevance does the work the volunteers at Standards Australia have and what relevant does NEHTA’s standards setting role have.

I would also bet the eRx infrastructure is not compliant with Series 2 Architecture Blueprints which we learned NEHTA is developing last week.

See here:

http://aushealthit.blogspot.com/2009/06/nehta-is-simply-not-ready-for-any.html

If I were involved in this work, volunteer or paid, I would be less than impressed that the whole thing is allowed to go ahead – and would be unlikely to get involved in future projects unless assured there was some point to putting in the effort!

There is also a real issue about what professional responsibilities pharmacists have to ensure the information being used for dispensing is utterly trustworthy. Scanning a barcode does have a (very low) error rate (ask Woolies and Coles) but just one wrong prescription being downloaded and dispensed would be one too many!

Last, I am sure we really don’t need anyone ‘clipping the ticket’ of e-Prescribing. There were 237 million prescriptions filled in 2006 – (Australia’s Health 2008) so even at $.25 per script we are talking a service costing near enough to $60 million per annum. Blowed if I can see that being a good deal for the public or the pharmacies (sounds pretty good for eRx however) – remember once the core infrastructure is bought / developed to actual cost per transaction is almost certain to be less than 1-2 cents each!

It is also important to see all this in the context of the upcoming Pharmacy Framework Agreement.

Pharmacists lobby for $1 billion federal funding

Elizabeth McIntosh - Friday, 10 July 2009

PHARMACISTS will be pushing for $1 billion in federal funding for pharmacy programs and services when negotiations for the Fifth Community Pharmacy Agreement commence later this year, though their requests may face stiff opposition from Health Minister Nicola Roxon.

Under the current agreement, pharmacists received $500 million over five years to provide services such as home medication reviews. However, Pharmaceutical Society of Australia (PSA) vice-president Dr Shane Jackson (PhD) said funding needed to double if pharmacists were to be adequately paid for their work.

“If we can establish [these activities] are improving outcomes for consumers and reducing doctors’ visits, [pharmacists] should be remunerated,” he said.

Pharmacy Guild president Kos Sclavos was reluctant to put a figure on negotiations but suggested newly launched electronic prescriptions would save the Government billions over the life of the next agreement, which could be used to expand the PBS.

More here (registration required)

http://www.medicalobserver.com.au/News/0,1734,4849,10200907.aspx

Someone needs to tell the Pharmacy Guild that the benefits of e-prescribing come from getting prescribing right at the medical end and providing an accurate easy to read prescription to the pharmacist. The benefits of the actual electronic transmission accrue to the pharmacist as efficiencies (why else would they be prepared to pay for each script?). The government would see very little benefit with a new system as they have most of it already.

The bottom line here is that unless this is all reigned in, and soon, there will be a lot of people who will have had their volunteer time wasted and a system which may, or may not, be in the national interest will come into place.

The merits and frameworks for a critical public good, as this will be, need to be decided by Government and no-one else in the context of the National E-Health Strategy. With this done industry can then go ahead and compete for space and profit within an appropriate national framework.

Get on with it Ms Roxon, and provide the policy leadership you were elected to provide.

David.

9 comments:

Anonymous said...

Let’s face it - the Guild intends to control the clipping of the e-script ticket.

Even at 10 percent market share and 25 cents per script it will enjoy $6 million per annum before amortizing the costs of development, and if it can get 10 percent it can grow over time to 60 percent or more. You do the maths.

No, it won’t be sharing all this lovely moola with it’s members. They are the monkeys who have to do the work and collect the money for the Guild to siphon away in its coffers to fight more battles, to beat up the government and intimidate the politicians. Bully boy tactics is the Guild’s modus operandi, nothing less, always has been. So if the government is so dumb as to let the Guild get its way then clipping the ticket will by the biggest bank hoist since Ronald Ryan’s Great Train Robbery.

Anonymous said...

All the more reason for competition.

There is nothing at all wrong with "clipping prescription tickets" if this is more cost-effective and better for patient safety that the way we manage prescriptions now (which ePrescribing most assuredly is!).

David (and the writer above), do you think that eHealth technology providers should deliver these solutions for free? Do you think the Government (any government) could do it better for less money? Neither do I!

I agree with you both 100% about the Guild and I am busy burning candles to the Virgin Mary for Nicola's victory in the PBS funding wars - but please don't let the Guild's usual ham-fisted grab for a market monopoly overshadow the real need for commercial, standards-based solutions (private sector delivered solutions!) just like this.

Anonymous said...

The first priority for the Guild it to negotiate (extract using painful techniques ie torture) as much money as they possibly can under the Fifth Community Pharmacy Agreement.

So we see the PSA’s Vice President, Dr Shane Jackson, being used to add power to the Guild’s elbow. In these negotiations the PSA will do what the Guild tells them to do. They are not strong enough in their own right to do otherwise. It’s a clever negotiating ploy the Guild has used successfully for years.

Each party (Guild and PSA) push their own barrows - united we stand - which has the effect of extracting more money for ‘the pharmacy lobby’ as both groups need to be satisfied (satiated would be a better description).

After every drop of blood has been extracted from the Government's Team then the contra deals are done when the big bully boy agrees to ‘put something back’ to sweeten the Government’s pot - like cutting its ambit e-script ticket clip in half (down to 12 cents per clip) and building in a growth factor tied to volume so the desperados in Government can look like they have done a great deal (magic and mirros). And because Nicola Roxon’s foot soldiers, and equally well those of Tony Abbott’s before her, have wasted hundreds of millions of dollars on the non performing MediConnect and NEHTA projects the Government will surrender absolutely and complicitly because time has run out and they now have nowhere else to turn.

End game is Checkmate for sure. Stalemate is not acceptable to either party.

Dr David More MB, PhD, FACHI said...

David (and the writer above), do you think that eHealth technology providers should deliver these solutions for free? - No.

But I do think there is a place for making such activities 'not for profit'. I also think governance of such infrastructure should ensure all stakeholders have appropriate representation an input with consideration of the public good and openness being uppermost.

The level of clipping proposed borders on usury and I am not at all happy with the proposed governance.

David.

Anonymous said...

I agree with both of you 100%. Keep the candles burning. Remember the old days when the Guild tried to steal public IP with its grubby attempts to patent MediConnect. In the end Government won the day but only because there were a few of us ‘out there’ helping expose the Guild for what it is. At first the bureaucrats would not listen but in the end they did so just in the nick of time and the Guild was persuaded to assign the IP rights in its Patent to Government and thereby, us, the taxpayers.

The same could happen here. The Government could insist the Guild and its software partners transfers the eRx Script Exchange into public ownership. But such an action will be fought vigorously in the courts and the Government will suffer and pay dearly. Anyway, because the way the Guild has structured the Exchange involves other third parties it makes it very difficult for Government to move effectively on that front.

So the Government has few choices left open to it. One is to buy, acquire, the Exchange from the Guild and its partners and it will pay dearly, ever so dearly for that option, or the other is to develop its own system and we know from past experience how pathetically hopeless that avenue would be. So, in short, it would seem the Guild holds the power, unless the doctors with Medisecure have something up their sleeve which is highly unlikely.

Anonymous said...

How many of these 150,000 are repeats? They were already e-scripts in the first place - they are simply now stored centrally instead of locally. How many are actual prescription originals?

Anonymous said...

In response to David More's comment above - I agree with you David - I don’t think eHealth technology providers should deliver these solutions for free.......

And I also agree, that in the specific case of e-scripts the activity should be a 'not for profit' one.

And I also think you are 100% correct, in regards to the governance of such infrastructure which should be such as to ensure all ‘key’ stakeholders should be represented and have an equal say.

Bottom line however is:
1. the fox should not be living in the chook house
2. the bowler should not also be the wicket keeper
3. the vampire should be banned from the blood bank.

Dr David More MB, PhD, FACHI said...

Reaction from an e-mail correspondent.

"In haste. One quick reaction is to throw in the towel and resign from IT-014 and get a life!

It would not surprise me to see a lot of that - and sooner rather then later.

Smart volunteers can only be messed about for just so long.

David.

Anonymous said...

eRx and MediSecure are also playing it smart by staying out of the PIP Secure Messaging project despite providing secure messaging to GPs. Why get bogged down with NeHTA/DoHA shackles.