The Ole' Apothecary

In the United States, there is an interesting tale of two cities: two Texarkanas. One Texarkana is located in the state of Texas, the other Texarkana adjacent to it, in the state of Arkansas. Crossing a street means entering (or leaving) a state. State laws and state pride have kept these two cities a certain political distance from each other. But wisdom may soon be overcoming traditional politics for this interstate municipality. An Associated Press story yesterday suggested that the two cities are pondering the efficiency that would be involved in becoming, partially, one. The potential savings involved in combining city services across the state border is $4.1 million. Some locals, such as attorney Hayes McClerkin, want to overcome the "territorial disputes and pride" that have blocked the commingling of revenue allocation across town. Translating the blinds of habit into economies of scale could set a great example for the rest of us, especially regarding the use of technology in healthcare.

Take my shoulder, for instance. I was in so much pain that I went to the local minor emergency center and had an X-ray taken of it. The E.R. doctor just thought I might have a touch of arthritis, but I begged to differ, and saw my orthopedist the following week. During his examination, I informed him about the X-ray taken a week earlier. He told me he could access it from the hospital's information system, right there from his office. Ten minutes later, he emerged with a detailed diagnosis for me: a bone spur. Focused exercise would help. Had he had to rely on retrieving a hard film to look at the image, I might have had to wait a day or two for him to order it to be shipped over to his office before I could ever get his clinical impression. But,, no longer---today, there is less waiting, less suffering, more action, and potentially, lower costs in many areas of healthcare.

Although my hospital set up a brand-new information system two years ago, and established computerized physician order entry (CPOE) just six months ago, the emergency department, run by a separate entity, chose not to opt in entirely. So, for STAT orders, it continues to insist upon sending orders on paper. The same order is in the CPOE system, but we in the pharmacy cannot act on them until the paper arrives. Meantime, to whatever extent one wants to measure it, the patient suffers. Turf is making the patient suffer. Who are we in pharmacy? Are we the enemy?

So, an additional blinder for us to remove here is the handwritten prescription. If I had my way, the handwriting of prescriptions would cease to be legal in the United States by 2020.

I've heard the current complaints over a lack of standards and a lack of formatting for the transmission of electronic prescriptions, and, of course, I don't disagree that we have problems in this area. So what? Sew buttons! It is time to correct those problems, and institute national standards for both transmission and connectivity of pharmacy information. It is time to smash the old turf lines of cutesy prescription blanks, perceived physician convenience, and sentimentality. Texarkana's calling!

In New Zealand, Go into Business-One Pharmacy in Auckland, to pick up your hydrochlorothiazide. Then, days or weeks later, say you are visiting Christchurch, and forget to bring your diuretic with you on the trip. You head into Business-Two pharmacy in that distant city for a refill . All pharmacies in New Zealand are connected. The pharmacist can call up your prescription information on a national network. So, HIPAA is a problem with this here in the U.S.? Maybe. Perhaps we need to examine, or amend, HIPAA to make this kind of connectivity possible from the mountains to the praries to the oceans white with foam. This kind of liberated information flow would be vital for a comatose patient bearing but a pocket ID in the ambulance.

I am originally from Massachusetts, and I remember studying about the Mayflower Compact, the first set of social rules among the people that would give rise to the U.S. We Americans of the 21st century need a digital compact for healthcare information. We need to emphasize the "P" in HIPAA. Anybody remember what the heck that stands for? Portable! We already have the tools and the skills to do it. Now, all we need is the handshake, both from hardware and from our hearts.