Pharmacy, the medicines experts

Pharmacists, through our professional organisation, the Irish Pharmacy Union, became the fathers of two major standards

While we are all familiar with the maxim that “success has many fathers, but failure is an orphan”, there is a corollary. The perfect success story can be almost invisible, where a seamless solution just works. In Irish community pharmacy, there is an unsung story of standards in medicines information, with associated EDI messaging. These have helped to drive developments in both efficiency and safety for pharmacy and the wider public that it serves. In the 1980s, computerisation was in its infancy. BBCHard disk advert from 1980s computers jostled with IBM PCs, Amstrads and Apple IIs. A 40Mb hard drive cost a king’s ransom and large lists were distributed on EEPROMs. Information standards were non-existent. Suppliers and software vendors jostled for dominance, all seeking a competitive edge through proprietary solutions. Emerging from this flux, a few issues were abundantly clear. The most obvious was the concept of lock-in. If pharmacists didn’t provide a solution, there was a real risk of getting tied to other people’s impositions. Pharmacists, through our professional organisation, the IPU, became the fathers of two major standards. One was a product file that was both commercially and technically agnostic. Distributed as simple text file, it provided current and reliable medicine information. The second standard followed from the first, a reliable electronic messaging system. While both these standards have evolved with the profession, they both illustrate the wisdom of a simple clear standard.

Data-driven pharmacy

InhalerToday, as I work in my pharmacy, the data-driven aspects of professional care are deeply embedded in every aspect of my practice. For instance, it is unthinkable that I would not have a complete medicine profile of a patient. More importantly, we can see what medicines the patient is actually collecting, as distinct to what has been prescribed. This facilitates much better patient care. By way of example, the challenge of asthma is ever present. As human beings, we are hard wired for instant gratification. This is both the blessing and the curse of the salbutamol inhaler. A typical query, checking the dispensing frequency of short-acting beta agonists against that of an inhaled steroid, shows a disturbingly familiar pattern in many cases. All too often, this ratio can be directly correlated with asthma exacerbations, featuring oral steroids, antibiotics and hospital admissions. These queries are facilitated by an underlying structure that accurately identifies the classes of drugs, in this case it is the WHO ATC code, which is not even seen during the process. The result is a pharmacist, screening for barriers to successful treatment, that can intervene in a positive manner. Ideally, we see a happier, better-controlled patient that is less likely to use expensive emergency treatment.

Pharmacy enhancements for everybody

At the risk of stating the obvious, reliable medicine information is critical to the rational and efficient use of medicines. It facilitates prescribing, dispensing, ordering, claiming, identifying, classifying and many more ‘ings’ that come to mind. The arrival of a national medicinal product catalogue, as an essential infrastructural resource, must be done in a way that improves patient care. Part of this is the near simultaneous arrival of Snomed CT. Putting them together is not a trivial exercise. Doing this accurately is a key task that requires a robust structure. The consequences of a poor rollout could be potentially catastrophic. Equally, a successful deployment could deliver serious enhancements for everybody. The pharmacy profession is effectively based on medicines knowledge. Now is not the time to overlook this vital resource.

Jack Shanahan

About Jack Shanahan

Jack Shanahan is a community pharmacist with extensive experience in medicines management. As well as running his own pharmacy, he has had a long involvement with the IPU information technology group. This involves setting IPU standards and representing the profession on various health informatics standards bodies. He is also editor of the IPU Review.

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