Government Briefs: Archives: A Call for Action - Report of the Task Force Year 2000

To: Standing Committee of Industry
By: Dr. Jeffrey Poston - Director of Research and Practice Development and Dr. Elliot Loh - Senior Research Associate
Date: March 9, 1998

Introduction | Association and Community Pharmacy Preparedness |
Potential Health Risks | A Call for Action | Conclusion

Introduction

The Canadian Pharmacists Association (CPhA) has been providing leadership for pharmacists across Canada for the past 91 years. CPhA represents pharmacists in all areas of practice: community, hospital, academia and industry.

The issue being studied by the Committee has been of major concern for pharmacists. As one of the most computer-literate health care professions, pharmacists depend on computers daily in order to document patient profiles, the medications they use and other pertinent sensitive information. They also use their computers for claims processing with a variety of public and private claims adjudicators. Over the years these systems have become online real-time. The complexity of this has multiplied with every new benefit program set up by insurers, benefit manager or managed care companies.

Having recognized the importance of computers for the profession early on, the Canadian Pharmacists Association has developed the Pharmacy Claims Standard (PCS) which is being revised and will be renamed the Pharmacy Electronic Communication Standard (PECS). All information going to and from a pharmacy electronically will follow PECS. Also PECS integrates elements of the HL7 standard to render it compatible with data collected by other health care professionals.

The issues about computers related to the Year 2000 are being taken seriously and acted upon both by the Association and by its members.

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Association Preparedness

At the association level, we are in the process of replacing all our computers, operating systems and software with Year 2000 compliant material. We are also doing some major work on the program supporting our Membership Services, Association Plus, in order to avoid problems. In accordance with recommendation 7 of the Report, we are letting our members know about the work being done in our annual review. Though all this work has entailed major costs for the association, the work being done should put us in good standing to face the turn of the century.

Community Pharmacy Preparedness

Pharmacists across Canada are in various stages of preparedness to be Year 2000 compliant. Some of the issues to be dealt with are within their control; others are not. In order to assess the current situation, and in preparation for this presentation, we have polled a number of pharmacy chains, independents, as well as software vendors who are working with all types of pharmacies to precisely identify the problems linked with the century change. In general, most pharmacies have already taken it upon themselves to get their systems Year 2000 compliant.

The problems being faced span three areas:

1. the hardware currently being used may not be Year 2000 compliant; in most instances this problem can be solved at the pharmacy level, although the solution may be costly and time consuming to transfer all the files and programs to the new computer;
   
2. the operating system may not be Year 2000 compliant; here again this problem will entail costs and time for pharmacy owners;
   
3. the software used may not be Year 2000 compliant; because of the numerous software vendors across Canada, this may prove to be the area that will provoke the most headaches for all concerned. One only has to look back at the problems faced by pharmacists in British Columbia during the installation of the PharmaNet network or in Quebec with their new system. Vendors were not ready in time and programs had bugs in them that needed to be ironed out as the program was being launched.

Note: Typical costs associated with pharmacy systems

From CPhA's perspective, the current Pharmacy Claim Standard is being reviewed and a document is being developed to provide instructions on how to adjust the system to make it Year 2000 compliant. The migration from the Pharmacy Claims Standard to the Pharmacy Electronic Communication Standard (PECS) provides advanced claims processing and patient health information capabilities. PECS is fully Year 2000 compliant.

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Potential Health Risks

There are also potential health risks associated with the Year 2000 non-compliance of pharmacy computer systems. They range from an incapacity to retain and/or maintain and search patient profiles, to an incapacity to transmit claims to the appropriate public or private payer.

Patient Profiles

Patient profiles constitute an important health tool in today's drug therapy. They enable pharmacists to assess whether a medication is right for the patient waiting for the prescription, to search for and detect potential drug interactions or adverse reactions in specific patients.

Depending on the province where they practice, pharmacists may be networked. In non-networked environments, should pharmacists lose their patients' profiles, the potential for health risks would increase. Pharmacists would have to rebuild the profile with information provided by the patient, and where possible, the physician. We expect some difficulties in rebuilding the full profile if it is lost, including allergies or adverse reactions to certain types of medications. Though pharmacists also do back-up of patient files, these files may not be compatible with the new systems. They may require additional workload to render them compatible. Both processes would be extremely time consuming and pharmacists would not get remunerated for this type of work. Pharmacies could also experience transmission problems which would create financial hardship for patients as well as pharmacists.

In a networked environment, non-compliance of certain computers can jeopardize the completeness of information about individual patients as well as the transaction back and forth with payers. If the pharmacy you go to experiences problems and can no longer communicate with the network, your patient profile will be incomplete and pharmacists may not be able to evaluate the appropriateness of the drug, taking into account your past history and other medications you may be taking, or assess if your benefit plan provides coverage for the medication prescribed.

Most of the networks we have contacted are assuring us that all their members are diligently working on ensuring that their hardware and software are year 2000 compliant.

Claims Adjudication

Software vendors and insurance companies have been actively addressing issues pertaining to the compliance of their own systems. All organizations that we contacted have indicated that they are working on, or have already completed, the necessary hardware and software upgrades to make their individual systems Year 2000 compliant. What remains to be determined is whether the upgraded systems will continue to be compatible when messages containing Year 2000 dates are exchanged. The proper integration of these systems is important for the uninterrupted delivery of pharmacy services. Current initiatives focus on the upgrading of individual systems and far less work is being done on the assessment of the compatibility of the upgraded systems.

It has been suggested that CPhA assist in the coordination of the integration of Year 2000 systems by acting as a central clearing house for information on the status of individual systems and the interoperability of the systems. Unfortunately, CPhA does not have the financial resources to fully meet this challenge.

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"A Call for Action" - Comments on Other Recommendations

The Canadian Pharmacists Association would like to express some concern about recommendation 3 concerning the need for lending institutions to require a formal Year 2000 action plan as a prerequisite for loans. Though such a plan may readily be available for large chains and networks, some independent pharmacists may be hard pressed to produce a full-fledged plan even though they are already in the process of addressing the issues around being Year 2000 compliant.

CPhA Recommendation

• that exceptions be made for small businesses who can produce proof of purchase of equipment upgrades, as well as for small businesses who wish to secure a loan to upgrade their equipment.
  
• We also feel that the same prerequisite for government grants in Recommendation 11 could put an undue burden on small associations.

The Canadian Pharmacists Association wholeheartedly supports Recommendation 15 on introducing revenue-neutral tax encouragement measures for small and medium-sized businesses. The additional financial burden put on pharmacies to be Year 2000 compliant comes at a time when most payers are trying to cut dispensing fees. In this context any financial assistance would be welcome.

Conclusion

As outlined above, because of their constant use of computers, pharmacists in all areas of practice have taken it upon themselves to actively address all issues surrounding Year 2000 compliance. Nevertheless, some problems may not have been foreseen and we will only find out when the fateful date arrives. The Call to Action document provides an opportunity to look at issues and prepare as much as possible. We must however continue to be vigilant, monitor progress and address new issues as they arise. As a profession, pharmacy will be ready for the Year 2000 and will continue to work in partnership with health care stakeholders, insurers and governments to ensure a smooth transition into the next century.

For more information, please contact:
Dr. Jeff Poston, Director of Research and Practice Development
Tel: (613) 523-7877 ext. 255 or 1-800-917-9489
Fax: (613) 523-0445

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