Early risers at the Conference on September 11 heard a debate over breakfast
that was chaired by the BBC Radio WM personality Ed Doolan, whose wife is a
pharmacist. On the panel were Mr Jasbir Sunner (chief executive, Stratford and
district primary care group), Mr Keith McCullach (Pharmacy2U/OnMedica) and Mr
John D’Arcy (National Pharmaceutical Association)
The internet represents an explosion in technology that has made it possible
to do many things that would have been inconceivable even five years ago, said
Mr ED DOOLAN. It was important for pharmacists to embrace technology rather
than ignore it, otherwise the profession could run into trouble. Mr Doolan opened
the debate by asking the panel how things currently stood with regard to e-commerce
in pharmacy.
Mr SUNNER said that he had successfully applied from Canada for his current
job using the internet. However, many people were still afraid of using the
web. Mr McCULLACH said that e-commerce involved the use of networks and communication
using the internet and interactive television. This could give patients better
control of their health care and medical records and change the whole culture
of medicine. Mr D’ARCY said that pharmacists currently relied mainly on
face-to-face contact and that e-commerce was perceived to be a threat. It was
important that a balance was achieved between the “good bits” of technology
and the “good bits” of face-to-face contact. Every health care professional
had access to different chunks of information but the patient had none. It was
important to co-ordinate this information.
It was possible that, in future, there might be a centralised database of medical
records, Mr D’Arcy continued. This would allow patients to go to whichever
health care professional they preferred. Mr McCULLACH said that the idea of
a centralised database worried him and he would prefer to let individuals have
responsibility for keeping their medical record database up to date. However,
communication in the NHS was currently inefficient. Notes got lost, there were
long waits for discharge letters — each component part of the NHS failed
to communicate with the others.
Mr SUNNER disagreed, saying that the technology for making databases of medical
records was available now. It was already possible to register medical records
on secure sites on the internet. People were hesitant about putting personal
details on these sites because they worried about confidentiality yet they had
no problem with transmitting equally confidential information to banks about
their finances over the web.
Medication record cards
Mr D’ARCY said that it was important that technology was modified to fit
pharmacy systems, not the other way round. Everyone walked around happily carrying
bank cards, so it should not be a problem for them to carry around medical cards.
The main problem was that, although people were beginning to conduct their banking
over the internet, the number was tiny compared to the amount of money that
had been spent on advertising the service. How was pharmacy to encourage people
when it had no money to run advertising campaigns? He said that one way of overcoming
this issue was for all health care professionals to make patients aware of systems.
Mr D’ARCY said that the NPA was trying to encourage community pharmacists
to use the available technology via the NHS intranet. Currently, few pharmacists
had a “web presence” — some were ignoring the internet, some
were overwhelmed by it and some were enthusiastic. It was difficult to enforce
use of the internet. Most leading pharmacists were not even using internet banking
services, so how could they say that other pharmacists had to use the web more?
The paradox was that pharmacies had been using computerised business-to-business
transactions for 20 years because it was advantageous to them to do so. This
was the key to getting people to use the internet — if it had an obvious
benefit, people would use it. At the moment, people who were using the web were
doing so for information but not for doing business. They tended to stop at
the “click to order” button and pick up the telephone.
Mr SUNNER said that the onus was on the individual to learn about the internet
and e-systems. Younger people tended to be more comfortable with the web.
Good position
Mr McCULLACH said that pharmacy was in a better position to take advantage of
electronic technology than general practitioners and, once procurement was made
easier using these systems, buying groups could become more powerful when ordering
and negotiating prices. There was patient demand for different access to over-the-counter
medicines and the internet would provide one of these options.
Mr DOOLAN asked what would happen to all of the information currently tucked
away in patients’ paper records. Mr SUNNER said that there was a move away
from having paper records and that, in 10 year’s time, they would no longer
exist.
Mr McCULLACH said that most GPs had paper systems but that these would be superseded
by electronic systems. The Department of Health, and health care management
generally, had put a great deal of thought into electronic patient records but
there was little mention in current plans of any commitment to linking pharmacies
into NHS information systems. Mr D’ARCY agreed, saying that the focus would
always be on doctors and nurses and not managers, pharmacists and all the other
health care professions. The advantage that pharmacists had was that there was
a hotchpotch of systems for doctors but many pharmacists already had computer
systems that incorporated patient medication records. If pharmacists, GPs and
the Prescription Pricing Authority were linked, it would be possible to implement
medicines management and pharmaceutical care because all of the information
that was stored would suddenly become available for everyone to use. Most GPs
would not have all the information that they needed to conduct good audits of
drug use but pharmacists did have it. Such a link would also make repeat dispensing
easier.
Controls
When asked whether there was a need for consumer protection, Mr D’Arcy
said that it was important not to be too dismissive of current controls on medicines
because product safety was more of an issue than it was with, say, foodstuffs.
Medicines were inherently dangerous. Control should not be paternalistic but
it was difficult to know the reliability of sites that offered mail order medicine.
The site might look good but there was no clue as to where the products were
coming from. It was important to have controls to give consumers the message
that drugs from this supplier were safe. A problem with websites was that the
more information the public was given, the more it would want to know and who
were they to ask?
Mr McCULLACH said that the pharmacist’s job was to provide information
but that it was up to the patient as to whether they took that advice. Patients
should have the choice of asking a pharmacist questions face-to-face or via
e-mail. He also pointed out that there were fraudulent high street pharmacies
and that “web pharmacy” was not necessarily unethical. Mr D’ARCY
agreed that there should be a choice of information sources for patients and
that face-to-face contact was not for everyone but added that it would be very
sad to end up as a nation who only communicated via the television set.
Mr SUNNER said that there needed to be a consistent level of service quality
and competence among all pharmacies. There was not necessarily any need for
a global gatekeeper of sites but some form of accreditation would be helpful.