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IT, e-commerce and pharmac-e!

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The Pharmaceutical Journal Vol 265 No 7106p132-133
July 22, 2000 Articles

IT, e-commerce and pharmac-e!

By Sultan Dajani, DipCommPharm, MRPharmS

Pharmacists ignore information technology at their peril. This article explains how to turn a potential threat into an opportunity

The pace and acceleration of change is daunting and, without doubt, the fastest growing and most influential current technological development is the internet. To underestimate the impact or magnitude of information technology (IT) on pharmacy would be reminiscent of the captain of the Titanic claiming his ship had hit an ice cube! While the majority doubt that on-line pharmacy services are a poor substitute for the real thing, trying to stop or slow down the tide of technological change through criticism or ignorance will not make it go away. Whereas it took the wireless five years to reach 10 million households compared with 22 years for the fax and 35 years for the telephone, the internet took just three. However, events in the UK could have proceeded even faster had there not been several barriers to overcome, like metered telephone calls and previous governmental trepidation. These things did not exist in the United States where, of course, the internet has spread a lot quicker.
Even now the value of e-commerce in the US, which is seen as the power house of the e-revolution, only amounts to about 1 per cent of all business, an apparently insignificant amount, making one wonder what all the fuss is about. But what does make it significant is the rate at which e-commerce is growing. Already the United Kingdom has a higher number of internet users per head of population than anywhere else in Europe. Recent estimates suggest that e-shopping will increase by at least 1,000 per cent over the next five years because it will be readily accessible, without the need for a personal computer, via mobile telephones and games consoles. And now, the advent of digital television means people can log on to the internet using their remote controls.
Even the experts do not know when or at what stage the growth of the internet will reach a plateau. There are no signs of its popularity abating; on the contrary, its use is increasing.
Tony Blair, the Prime Minister, recently declared the internet to be an integral part of Britain's future progress and chillingly prophesised that companies not on the net by 2000 would suffer lost sales and revenues. This statement applies to both professional and commercial aspects of pharmacy. It is clear that the real threat of the internet does not lie in e-commerce or e-pharmacy but in the ignorance of them.

What's the fuss?

All this is happening simply because millions of computers all around the world are able to communicate and share information with each other. The word internet (or net) is used to cover a number of activities, with the most commonly used ones being the world wide web (the web), e-mail or news groups. Together they form the world's biggest library, which doubles as a quick and cheap communication centre - as an alternative to faxes, telephone calls or letters - with conversations being held all around the world at the cost of a local call. However, in this fierce competitive environment all calls will eventually be free; indeed, some companies have already abolished their monthly subscription fee altogether.
Another good reason for going "live" on the net is because it encourages us to communicate with each other, to exchange experiences and participate in topical forums like Private-Rx and Pharmweb. In this way we are able to communicate with a limitless number of people simultaneously and thus reduce our professional isolationism, forge ideas, solve problems and share information. We would also be able to communicate with other health care professionals and have access to web pages of organisations like the Royal Pharmaceutical Society and the NPA intranet.

Information access

However, even more spectacular than this is the world of wisdom at our fingertips. The web is also a limitless information centre, open 24 hours a day with access to an unlimited range of topics and clinical information. But we are not alone in being able to access this information: clinical information is available to our patients, too. This means that more of our stakeholders are becoming "expert patients", taking a greater interest in their health and becoming more informed on medicines and diseases.
This will impact on certain aspects of our professional relationships with consumers, patients and other health care professionals, on the way we do business and, of course, on our professional roles. One of the reasons for this is that the focus on health information will increasingly shift away from general practitioners and on to the net, and pharmacists, being more accessible, will be needed to endorse the information.
Pharmacists and NHS Direct could have a role here as providers of information on patient support group sites and in answering people's questions. Thus, while the vast majority of our colleagues do not welcome the future of e-commerce with open arms, the implications for pharmacies wanting to stay ahead of the pack are enormous.

Government backing

Another example of the forthcoming changes is Whitehall's newly published Electronic Communications Bill which paves the way for electronic contracts. It states that authorised and authenticated electronic signatures on e-mails will constitute fully legal, binding and legitimate agreements or contracts. So, considering that a prescription is a contract for dispensing which is legal once signed, electronic prescribing will be a step nearer to reality in 2001.
In March this year, Gordon Brown, Chancellor of the Exchequer, announced that small businesses are able to write off against tax the full costs of purchases of computers or investments in e-commerce and that businesses filing their tax and VAT returns via the net would receive a £100 tax cut. Furthermore, there are plans to enable pharmacists to gain entry on to the NHS intranet to access patients' electronic health records. This would allow accredited pharmacists to perform differential diagnosis, to prescribe more effective over-the-counter medicines and to practise medicines management more effectively. With electronic prescribing around the corner, surely it would make sense to be on the internet now so as to be prepared for the future.
Other uses for the net include business-to-business transactions (B2B) whereby pharmacists can manage and procure stock, buying insurance, and downloading up-to-date staff training and continuing education packages. But the most fundamental changes have already begun with the business-to-consumer (B2C) culture, as a result of which the development of cyber-pharmacies has already begun.
The net revolution is exciting with its limitations bound only by imagination. And this is where the real problems - as opposed to threats - really lie, because it is proving impossible to regulate the net with the same type of legal controls that ban offensive and objectionable material on radio, on television and in newspapers.
So, while e-commerce is breaking down many national boundaries and international regulations in most of the business sectors, it has only caused a relatively small dent in the European pharmaceutical markets. Strict controls on marketing, advertising and sales of medicines emphasise that medicines are not ordinary items of commerce. But, as highlighted by Which? recently, medicines can be easily obtained on the net with no regard for quality, safety, effectiveness, storage controls or even licensing laws. This poses real risks to health and is one of the reasons why the National Pharmaceutical Association is firmly opposed to the promotion of medicines for sale via the internet, alhough it does support an "e-hallmark" for internet health advice.
The World Health Organisation and countries in the European Union also have concerns about e-commerce in relation to medicines, mainly because of Europeans buying unregulated medicines from outside the EU and then bringing them in. Some member states, eg, Germany, have taken hard-line approaches banning on-line pharmaceutical transactions, even if these are legal in the country where the business is based. However, the EU is softening its stance, preferring to see e-commerce as a legitimate alternative to the legal but expensive practice of jumping on a flight to the US to buy the medicines.

Regulation

In the UK, the pharmaceutical industry faces legal and ethical problems with e-commerce because the NHS contracts structures, the Medicines Act and the Royal Pharmaceutical Society's Code of Ethics have not previously addressed the introduction of e-commerce because they all support a pharmaceutical service founded on the physical proximity of the patient to a pharmacy. Recently, however, the Society has revised its Code of Ethics, realising that, while it would be impossible to stop sales of medicines on the internet, it would be more feasible to introduce good practice guidance, to monitor sales and to regulate supplies from existing premises that can be inspected.
The new Standard 19 in the Code of Ethics stipulates many conditions, one of which is that all pharmacists providing on-line services must advise patients to consult a convenient pharmacy whenever a request for a medicine or the symptoms described indicate that the patients' best interests are better served by a face-to-face consultation. Record keeping of all products, including OTCs, sold via on-line services is a necessity.
The same standards state that all on-line pharmacists will need professional indemnity insurance in place and, whereas the provision of product information on a website may constitute an advertisement, the requirements of the advertising regulations must be adhered to. In addition, all information and advice must comply with quality standards. As always, pharmacy services must be provided according to the best possible standards of security and confidentiality and pharmacists must be accountable for them.
The Society is also involved in proposals encouraging the development of codes of conduct at EU level. These would address consumer protection measures to reduce the risk of illegal activities and establishing guarantees and systems of redress, including electronic, out-of-court dispute settlement mechanisms.
Governance is needed in this chaotic environment, especially in pharmacy e-commerce. When Chemistore unveiled its pre e-commerce pharmacy website at the end of August, 1999, it was the first time in the UK that there was a concerted effort to challenge the accepted norm that medicines could not be sold on-line or via mail order. Then, in November, 1999, Pharmacy2u opened, announcing itself to be the trailblazer of on-line standards, and it registered over 3,000 hits within its first weekend. British Telecom also aims to become a major player in the pharmaceutical industry with an on-line system called BT Clinical Trial Services which will use the internet to cut costs and speed drugs to the market. It does not just stop here.
AAH has recently launched a pilot involving 350 pharmacies. Its system includes on-line ordering, stock information, e-mail, a news forum and various other B2B facilities.
Numark and the NPA have recently been recruiting community pharmacists to join their Intrapharm net. The Getwellkwik website and the National Co-operative Chemists portal offer on-line consultations as well as other B2C services. The British National Formulary is now on-line providing up-to-date prescribing advice and information based on the paper version, but having additional complementary sections, such as poisoning graphs, cardiac risk assessment factors, new developments and product news. Some hospitals, like Addenbrookes, have already formularised an intranet version for their local needs.

Catalogue

Already, a website catalogue for a national wholesaler is in the pipeline, promoting the whole catalogue range of products like disability aids, toiletries and consumer merchandise (excluding prescription-only medicines). These are items that the pharmacist would normally only obtain to order, and the site tells the customer which local pharmacies it can deliver to. The customer could then order items on-line and have them sent to the pharmacist, who would be notified by various means, or order them from the pharmacist themselves.
Epharmchem, a community pharmacy internet portal, is offering free PCs and internet access to pharmacies registering with it. In return, the pharmacies would expect to be able to access real-time generic and parallel import prices from around 30 wholesalers. They would also be able to book locums, circulate announcements and news and be part of a marketplace for the buying and selling of pharmacies.
It can get confusing and disorientating trying to pick one's way through the net minefield with so much going on at frightening speed, with so much on offer and so much to understand. Anyone involved in business will need an internet strategy.
The real problem is not change, but how pharmacy, and especially community pharmacy, will adapt to the evolving IT environment. Pharmacists' ability to survive will depend on two factors. First, they must understand the implications of what is happening in the IT environment. Second, they must use IT as a tool which would help to publicise their general pharmaceutical services and highlight their expertise (the "click and mortar" approach).

Summary

E-commerce will not be a threat to most pharmacies as it cannot compete with the high quality, personal service that is centred and oriented around the needs of local communities. Neither can technology replace the pharmacist's expertise, his or her personality or the fast delivery of services. A real threat does, however, lie in the potential loss of 80 per cent or so of repeat dispensing business. Pharmacists, therefore, need to provide real pharmaceutical care alongside dispensing and this needs to be done preferably in collaboration with local health initiatives.
The Society's Council is not seeking to obstruct the development of any of these services by pharmacists or pharmacies. If it did, it would mean that, in areas where pharmacy has competition, others would provide services which would be to the detriment of the profession and the public. Pharmacy's future must develop in line with such changes in the retail and commercial environment, and even though the NPA is firmly opposed to the promotion of medicines for sale via the net, this should not discourage pharmacists from independently developing their own internet strategies.
The net represents a way of getting not only into people's businesses but also into their homes, and it is surprisingly easy to set up one's own website. Websites are cheap, easy to maintain, can be updated regularly and focused on one's locality, and the more ambitious one gets the more expensive they become. They will generate income and are a powerful tool for promotion and marketing. Using their websites, community pharmacists can highlight their promotions in liaison with their wholesalers, and can provide information and publicise their services as well as all their goods.
The Government is totally committed to e-commerce and its objectives are well-known. They are to have:

  • The UK as a centre of e-commerce by 2002
  • 80 per cent of British businesses and homes to be on-line by 2004
  • 100 per cent of governmental services to be available electronically by 2008
  • Any restraining barriers removed and confidence instilled in the encryption processes

Furthermore, a total block of pharmacy sales on the internet is not an option favoured by the Government or consumers. It will be seen as too protectionist. At present there are 17 million internet users in Great Britain which is 30 per cent more than last year. Yet, amazingly, 72 per cent of the independent sector do not use the internet feeling that it is a waste of time.
The internet continues to expand and, while no one has yet recouped any money from internet pharmacy services, one thing is for sure. Pharmacy service providers that do not jump on the internet bandwagon now will find it hard to do so once it has started rolling. Pharmacists must think global and act local.

Sultan Dajani is a member of the Royal Pharmaceutical Society's Council

Citation: The Pharmaceutical Journal URI: 20002264

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