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Laurence A Goldberg
HPE Editorial Consultant
The theme of the meeting was “open mind, open space”, and presentations were designed to raise awareness of the challenges posed by social, environmental and technical changes and to encourage pharmacists to consider new ways of working to meet the challenges. Prominent topics were electronic prescribing and automation of pharmacies.
Electronic prescribing was a topic of broad interest, and presentations from Spain and from the UK illustrated some of the different approaches that are possible.
“Nowhere else in Europe are electronic prescribing projects as well advanced as in Spain, although there is still the challenge of interfacing systems,” said Javier Herradon (Treasurer of the General Council of the Colleges ofPharmacy, Spain).
In Spain, a standardised printable prescription form, which includes a 2D barcode for patient identification, has been in use since 1984. The introduction of electronic prescribing and electronic transfer of prescriptions provides the opportunity to optimise the quality of the pharmaceutical service and to eliminate duplication errors. It will also help to support effective working of the multidisciplinary healthcare team.
All people in Spain carry a smart card for health (tarjeta sanitaria). When the patient visits a doctor and a prescription is written it is then uploaded onto a central server. Patients are free to visit the pharmacy of their choice, where they hand in their cards in order to authorise the pharmacist to access their prescriptions. There are advantages for everyone in this system, explained Mr Herradon. From the patient’s viewpoint, there is better monitoring of pharmacotherapy, medication errors can be prevented and it is more convenient for people with long-term conditions. For the pharmacist, it optimises the quality of benefits, simplifies paperwork and facilitates integration into the wider healthcare team through the use of new technology. From the administrative viewpoint, it provides coordinated systems for dispensing and it improves the level of control. It also makes good use of new technology in the pharmacy environment.
Electronic prescribing has developed at different speeds in different centres, and it will eventually be necessary to have functional and technical harmonisation at national level. In particular, a common coding system for all products, processes and diseases will be required.
Comprehensive databases, well-developed computerisation, and good accounting and payment systems are essential for the implementation of electronic prescribing. A total of 96% of pharmacies are already computerised, noted Mr Herradon. In many places, compatible systems are already in place.
In the United Kingdom, the implementation of new technology has brought many benefits and electronic handling of prescriptions is fast becoming a priority, said John Oliver (Head of IT, United Co-operative Chemists England). In the National Health Service (NHS), 1.3 million paper prescriptions are written every day, 70% of which are repeat prescriptions. The total number is increasing at the rate of 5% per year. The NHS is planning to implement electronic prescribing by 2007-8. Electronic health records already exist in the NHS. At present, patients collect prescriptions from doctors and take them to the most convenient community pharmacy. In the new (electronic) system, the doctor will ask the patient during the consultation to which pharmacy the prescription should be sent. This opens interesting new possibilities, noted Mr Oliver. For example, large supermarket chains with established delivery services, which also have pharmacies, could easily add the delivery of medicines to the services that they currently provide. “Chains that market well will do well,” he predicted.
At present, processing of a prescription is a five-stage paper chase that adds no value for anyone and is not auditable. New technology offers the opportunity to streamline the supply chain, so that, for example, pharmacies could order the products that they expect to dispense rather than simply restocking those that have just been dispensed, as is done at present.
An additional monthly allowance will be available to community pharmacies in the UK that have installed computer equipment suitable for electronic transfer of prescriptions. Describing how the scheme would work, Richard King (Pharmacy Consulting Ltd, United Kingdom) said that pharmacists would receive a e5,000 payment and then a monthly allowance of e280.
Trends and developments
New information technology will turn current expectations on their heads, and the internet – as a means of information transfer – will play a large part in this, according to Virginie Saurel (Journalist and Communications Consultant, France). At present, use of the internet is dominated by the UK, where it is estimated that 73% of people have bought goods online. The corresponding figures for other countries are: Germany 66%, France 59%, Spain 28% and Italy 28%. Other European countries will swiftly follow the British example, she predicted.E-commerce is expected to grow to more than twice the current level in western Europe by 2010.
Automation in France
“Pharmacy, generally speaking, is no longer the exclusive possession of pharmacists,” according to Claude Remy (Director General, Alrheas Group, France). Reviewing the numerous social, environmental and technical changes that have occurred in recent years, he concluded that pharmacists had been in a comfortable position in the past but that keeping up to date was now critical. Automation presents wonderful opportunities, but if the pharmacist does not comprehend the benefits and the possibilities then robots could become enemies. The present generation is comfortable with vending machines, and technically it would be possible for a patient to use his/her smart card to collect all medicines from a vending machine without the intervention of a pharmacist. Robots could even deliver individual doses if required.Mr Remy urged pharmacists to treat robots as tools and concentrate on added-value activities. One such added-value activity might be medicines use reviews.
Richard King explained that community pharmacists in the UK could, under the terms of their new contract, be paid for undertaking individual medicines use reviews with patients. The purpose of the review is to improve patients’ knowledge and use of their medicines. Only pharmacists who have undertaken appropriate training and who have a private consultation area in their pharmacy can carry out medicines use reviews. Each review is expected to take about 20 minutes to complete, and there is a standard form for recording the findings and recommendations. The pharmacist is paid e32 for each review and, at present, is permitted to carry out a maximum of 400 reviews per year. Automation of the dispensing process would be a good way to liberate the time to perform medicines use reviews, noted Mr King. Other examples of added-value services include smoking cessation services, provision of treatments for minor ailments (without prescription), services to care homes and supervised administration of medicines such as methadone or buprenorphine.
Commenting on research that showed how pharmacy staff take longer to unpack and put away goods after lunch than before lunch, Rupert Katritzky (Chief Executive Officer, ARX) pointed out that with modern dispensing robots there was no need to do this by hand; the technology for automatic refilling of machines is well developed and functioning in many places.
Environmental awareness was an underlying theme in the conference. The Italian architect Alfonso Moligno had designed the exhibition floor to emphasise the links between interior and exterior. The exhibition stands were arranged in a circle, and living turf covered a large area of the floor. An extra feature was the recyclable exhibition furniture – chairs, coffee tables and display stands made of corrugated cardboard. In addition, conference participants were given document wallets that also opened up to form corrugated cardboard portable seats. Pharmacy needs to understand how to combine a space dedicated to harmony and wellbeing with its commercial objectives, explained Mr Moligno.
There are two big trends that will influence the development and delivery of pharmacy services, namely the “global village” phenomenon, in which we see increasingly standardised products, and the regional or individual approach. The first is exemplified by MacDonalds, which provides the same products everywhere, and the second by Dell, which allows individual customers to choose the specifications for their personal computers. Customer relationship management will now become increasingly important in pharmacy.
Question and observe your customers regularly to work out what you can do for them, recommended Alexandre Blaizot (Info Decision Conseil, France). Every population will contain a mixture of different generations with different preferences for the ways in which they seek and receive information. For example, telephone and SMS messaging could be a useful way of communicating with some groups. Increasingly patients arrive with information that they have already researched for themselves on the internet, but they need explanations and guidance.
They need the information to be personalised. Moreover, pharmacists should not forget that clients will often pay more to get the service that they want, and so building good relationships and client loyalty is essential.
Another key element of service and customer management is having a good understanding of the aptitudes and strengths of the pharmacy staff themselves.