Professor NICK BARBER (professor of the practice of pharmacy, School of Pharmacy, University of London) opened his keynote address by asking whether technology was really of benefit and, if so, at what price? Technology could increase efficiency and effectiveness but so could humans. Thus, he said, electronic systems and new technologies had to be evaluated following their installation to see whether they had made a difference.
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Nick Barber: does technology live up to its promises? |
Technology in hospitals . . .
He gave an example of technology that had proved its worth in pharmacies in four London teaching hospitals. This was a labelling system that had taken 16 seconds to produce one label compared with one that had taken 39 seconds (Int J Pharm Prac 1992;1:193). This equated to 62 person days per 100,000 labels produced (estimated as 7.4 working hours per day) as opposed to 148, which was a substantial saving of staff time, he said.
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Conference participants listen to the keynote lecture |
. . . and community pharmacies
Next, Professor Barber described a project whose results had emphasised the need for information technology to meet the needs of people rather than the opposite. A small number of community pharmacists with an interest in IT had been asked how they thought an IT system could help them in their work. Most had hoped that a computer in the shop would provide patients with a counselling and information point and would assist the pharmacist with prescribing support and provide links to general practitioners, other community pharmacists, hospitals and homes in the area.
The pharmacists had been provided with a computer, a modem, a printer and access to information packages, such as Healix (health intelligence exchange), the internet and CD-ROM versions of the British National Formulary, the Merec Bulletin, Micromedex, e-PIC and Pharmline.
At the end of the project, most pharmacists had found the systems to be of great help in providing information to patients and in helping with "Daily Mail syndrome" (in which patients came into the shop clutching a newspaper article on health or drug-related issues). It had been less effective as a communication tool, as other health care professionals often did not have the necessary computer packages.
There had been both a learning curve and a learning "precipice", Professor Barber commented. Some pharmacists had begun learning how to use the systems before getting fed up and frustrated and giving up completely (ie, falling off the precipice).
Most alarmingly, he said, being ahead of other health care professionals technologically had been seen as a weakness by the pharmacists rather than the strength that it so obviously was. He thought that that was dismaying as it was an opportunity for pharmacists to take the lead in establishing communication policies in primary care groups. It was essential that pharmacists saw IT as supporting their professional ability to tailor information to the needs of individuals. The alternative was that IT would supplant them.
Miss NADA SAVITCH (PJ website controller) gave the audience an overview of PJ Online, The Pharmaceutical Journal website (www.pharmj.com). PJ Online would not take the place of the printed Journal but it did allow rapid searching of past issues, it reached a worldwide audience and did not require storage space. Thus, the printed and electronic versions of the PJ would complemented each other, she said. It was important that pharmacists had a website that could be relied on to provide quality information.
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Nada Savitch: PJ Online continually improving |
Since its launch, PJ Online had developed considerably. It now included a special section for pharmacy students (incorporating Tomorrow's Pharmacist), an events database and full text versions of sister publications, such as Hospital Pharmacist and Primary Care Pharmacy.
Miss Savitch explained that the contents page of each issue appeared on the website by 5pm on the Thursday before publication and each article or news item was linked to the contents page. Hypertext links to previous articles or websites highlighted within stories were included and it was possible to browse through previous contents pages. The daily news service was one example of the website's ability to offer more than the printed edition. Each day, news stories were added to the site as they were written by the editorial team. The most recent headlines appeared on the home page and were linked to the full story once The Journal had been published. Searching archive material using keywords or phrases was possible and the findings of any search were ranked according to the relevance to the search terms used, she said.
Advertisements were divided into two separate databases on the website - recruitment and non-recruitment classified. It was possible to list advertisements by geographical area, by company name or by full-time or part-time vacancies. She demonstrated how searches could be combined to provide, for example, all part-time vacancies in Wales or all overseas positions.
Miss Savitch emphasised that PJ Online was continually improving in response to the needs of users. Enhancements to the site that were already under development included e-mail alerts of current contents, a date searching facility, the addition of Pharmacy Assistant and advertisements with links to information about the advertisers.
In the future, PJ Online might become more interactive. Background and detail on specific stories that did not appear in the paper version might be made available, together with online letters and dedicated areas of editorial content for specific subject areas.
Pharmacists at the meeting were urged to be aware of what information patients were seeing on the world wide web. Mr SHAPOUR HARIRI (IT project manager, Guy's hospital drug information centre, London) advised the audience to look at the NHS Direct website (www.nhsdirect.nhs.uk), which was soon to be heavily promoted to patients. Other information that patients could access were summaries of product characteristics and datasheets, all of which were on the web. Some business information, for example, that from the National Pharmaceutical Association's website, might also be seen by patients.
Patients were able to find information on minor ailments, medical conditions, medicines, and travel health. "They see the same information that you see," said Dr Hariri.
However, information from the web would also help pharmacists in such areas as drug dosage and formulation recommendations, compliance counselling, and providing health information.
Many pharmacists were now involved in primary care group work, running specialist clinics, and educating general practitioners. Access to information from the web would help them in these tasks as well as in continuing professional development and further education. Indeed, web technology and "virtual classrooms" were causing a revolution in the education sector, said Mr Hariri.
During his presentation Mr Hariri demonstrated the London, South East and Eastern drug information centre's website (www.druginfozone.org). This was a site that he had designed, which was one of several sites that could provide the necessary back up information to give pharmacists the confidence to deliver value-added services, he said.
The services provided by the Royal Pharmaceutical Society's information centre were described by Mr ROY ALLCORN, the head of the centre.
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Roy Allcorn: future developments outlined |
Theophilus redwood
The library had been set up in 1841 and the first librarian, Theophilus Redwood, had been appointed in 1842. The library currently provided the usual services - lending books, photocopying and providing databases for visitors to use. However, the heart of the library was its catalogue, which had progressed from simple card indexes to the new computerised system that currently operated. The new system was turning the traditional library into a "hybrid" library, as it was now possible, through the internet, to link a catalogue entry directly into websites that displayed the original article in full, which could, in turn, be printed.
In the future, the catalogue itself would appear on the internet allowing members to reserve and renew items online. It would also be possible to search Pub Med, a website that gave free access to the journal database Medline, directly from the catalogue. Other developments for the future were a database of frequently asked questions, loan requests and the museum database, all of which would be made available online to members.
Mr Allcorn said that the museum had maintained a historical record of British pharmacy practice and of the Society since it started in 1842. The collection included many valuable and interesting pieces, as well as information on pharmacy throughout the years. Members of the public were given tours of the museum and their inquiries were answered by the museum curators. In the future, the information that currently appeared on the Society's website about the collection and services provided by the museum would be made more extensive.
The technical information centre provided drug information and answered pharmacy practice inquiries. To do this, the centre's staff used the library's extensive facilities and the Society's electronic pharmacy information coverage (e-PIC) system. The e-PIC database covered 25 journals and included 48,000 references from 1992 to the present day. It also included new and discontinued products and was available by subscription on CD-ROM, via the internet or on the NHSnet.
More information about services currently provided by the information centre, could be found at the Society's website (www.rpsgb.org.uk). This listed, among other things, recent additions to the library, a journals holdings list, links to other relevant websites, research services and museum events.
The internet was an ideal means of sharing information with colleagues in the United Kingdom and abroad, Dr TONY D'EMANUELE (director and co-ordinator of Pharmweb, school of pharmacy, University of Manchester) told the meeting. But the internet was more than just a powerful new tool: it was a communications revolution which was having a massive impact on the world of information technology and in other areas, such as banking.
The most exciting thing about the internet was that it provided access to a global community with whom one could communicate.
"By embracing the new technology, we will be able to control its impact on us," said Dr D'Emanuele.
Professional brand image
Dr D'Emanuele went on to talk about Pharmweb (www.pharmweb.net), a structured pharmaceutical information server on the internet, which he had set up in 1994. Pharmweb had strived to create a professional brand image. It was managed by health professionals and, being non-commercial and university-based, it was perceived as being trustworthy.
Pharmweb had a large readership composed of patients, health professionals and scientists in over 160 countries. It received over one million hits per month from United Kingdom users and was part of a network of mirror sites allowing fast access to local information around the world.
In response to user feedback, the site was in the process of being redesigned. More money was being invested in it and its content was being revamped. Dr D'Emanuele said the site would try to maintain its community of users and its trustworthiness.
The National Health Service's strategy for health information was described to the meeting by Mr PETER DRURY (head of information policy unit, NHSE).
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Peter Drury: different needs of different people |
NHS professionals wanted accurate, complete and immediately available information about individual patients. They wanted access to guidelines and knowledge bases to support clinical decision making as well as access to information that would help them evaluate their own effectiveness.
NHS managers wanted better information to determine what worked and what did not, as well as relevant and reliable information to assess the health of the population and meet priorities in health care. They also wanted accurate information to support the most effective targeting and use of resources.
Finally, the public wanted access to trustworthy information on health and lifestyle to support self care. They also wanted open information about the performance of the NHS and information to help them influence the shape of policy and services.
To satisfy these different needs, the NHSE's information strategy had set specific targets. These were:
Mr Drury went on to examine electronic prescribing in more detail. It was included in the strategy because it would improve clinical effectiveness by linking treatment to outcomes and by improving the quality of clinical data. It would reduce the risks inherent in paper prescribing.
Electronic prescribing had several benefits. One of these was that it would reduce paperwork. For example, in hospitals it would allow an automatic printout of a patient's discharge medicines in the pharmacy department. Associated with that could be a printout of the patient's discharge letter and a patient information leaflet.
Another benefit was that it would allow rule-based prescribing in terms of dose validation, drug interactions, and duration of prescriptions.
Electronic prescribing would also benefit primary care, in as much electronic prescribing in the community could play a key role in the development of electronic health records.
Mr Drury said that the development of electronic prescribing would provide a win-win situation for patients, clinicians, pharmacists, managers and the pharmaceutical industry. He told the meeting that information on IT for the National Health Service was available from two websites: that of the NHS Executive information policy unit (www.doh.gov.uk/nhsexipu/index.htm) and that of the Information Authority (www.nhsia.nhs.uk).
The application of modern information technology could result in personalised medicines information being available to patients from the world wide web through their own television sets, Dr THEO RAYNOR (head of division of academic pharmacy practice, University of Leeds) told the meeting. Soon, he said, everyone would have a digital television set and access to the web could be gained through a simple remote control or even by voice. "WebTV" would become the norm.
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Theo Raynor: pharmacists must adapt |
Progression
Dr Raynor believed that the availability of web-based leaflets was a progression from the availability of electronically generated leaflets, which was the favoured way of dissemination of medicines information for patients in the United States and Australia. The advantages of computer-generated leaflets were that they could be produced at the point of supply, handed directly to the patient, used as an aide memoire, given only at the first supply of the medicine and updated as required.
Other benefits were that the leaflets could be personalised to include the patient's name. Dr Raynor said that personalisation of leaflets had been shown to have a powerful effect on a patient's perception of information leaflets and their relevance. The information contained in the leaflets could also be individualised for patients, ie, the leaflet could be in large print for partially sighted patients, it could be in a patient's preferred language and could cover information in as much depth as the patient desired.
Currently on the world wide web, manufacturers' leaflets were available from a UK site (www.emc.vhn.net). But the law required that such leaflets were posted on the web with their content unchanged and this meant that individualisation was not possible. However, leaflets produced by parties other than manufacturers were outside the scope of EU law and it was in this area that progress would be made. Such leaflets could be individualised by the patient answering a few questions on their age, sex and whether they wanted brief information or full details. With the availability of information in this way, manufacturer's package inserts could become just a legal back-stop, said Dr Raynor.
Pharmacy's role
Turning to the pharmacist's role in all this, Dr Raynor said that information technology would not just affect pharmacy practice on the dispensary side of the counter. It would also have an impact at the counter, where the provision of electronically generated leaflets would take place. It would also affect the ability of patients and other health professionals to access medicines information via the web.
A consequence of this was that pharmacists were no longer the guardians of medicines information for the patient. They would have to adapt to a new pattern and research was needed to explore the options. However, Dr Raynor believed that the pharmacist would act as the patient's guide to and interpreter of the information, and would also help to reinforce the relevance of the information to the patient.