Virtual Pharmacy in Europe Mar01

A medical diagnostic machine (MDM) - the size of a 50cm Television screen - mounted on the wall of a bathroom (a standard fitting) has a digital camera, audio-visual phone, email, PC, printer and diagnostic testing facility for body temperature, blood, urine and blood pressure. It allows instant contact with the local Doctor's surgery. It transmits high-resolution pictures of skin or other body parts. It can electronically transmit the results to both the Doctor and a hospital consultancy service for analysis, diagnosis and for issuing prescription for required medicines. The prescription is emailed to the appropriate wholesaler of medication for delivery by courier to the patient, complete with instructions for dosage, storage and an explanatory note of tests and the nature of the illness. A copy of the prescription is automatically recorded on the Doctor's database as well as the patient's medical card.

The MDM is regularly serviced for inputs by service contractors and the cost of this, as well as the cost of the consultation and medicines, are billed electronically to the health insurer, e.g., government or private insurance company or a combination of the two. Every person has a pin number and a medical card with a photo. Such a card, regularly updated with the medical history of the person, allows direct access of medical information wherever and whenever required.

Although there is already technology that can allow such practice to be implemented, the European apothecary need not fear for a while! Clearly, there are substantial savings for governments, private health insurers and industries employing large labour forces in using virtual health delivery programmes. However, there are many patients, especially the elderly in rural areas, who will miss a personal visit to their local pharmacy (apothecary) to enjoy a chat with the pharmacist - a reassuring experience that may still have some medical value!

In Denmark it is almost impossible to start a new pharmacy shop as one has to buy an existing business from a willing seller. In Sweden all 900  pharmacies countrywide are owned by the Government - a state monopoly! In Finland a pharmacist can own a maximum of 4 pharmacies except the University of Helsinki which owns 16 pharmacies. In most continental European countries, only a pharmacist can own a pharmacy and only medicines may be sold.  In the UK, anyone can own any number of pharmacies and sell anything including food, cosmetics and cameras. There are also differences in curriculum of pharmacy courses and training leading to professional registration. There is as yet no implementation of EU directive for mutual recognition of qualifications. Antibiotics and other prescription-only medicines are available without prescription in some EU countries and not in others. A Doctor's prescription from one EU country may not be accepted in another country causing considerable difficulty for frequent travellers requiring repeat medication for diseases such as asthma, blood pressure and diabetes. The same medicine can vary in price by more than 100% in the different Member States - a difference that cannot be justified and which inevitably leads to parallel importation profiting the middlemen. In many continental European countries, the pharmacist is perceived as a professional commanding high respect, status and income - in the UK, the retail pharmacist is not held in such high esteem. To this day, the apothecary continues to operate in a protected way unaffected by the Single Market of the EU!

Information should be, but currently is not, at the centre of healthcare delivery. Very few patients have in depth knowledge of their illnesses and the best treatment options. They rely on their Doctor’s judgement - a judgement that may be made without use of appropriate equipment, testing facilities and information on availability of hospital beds and specialist consultants. Doctors are unable to instantly access previous medical records of new patients thereby exposing them to further risk.

The advances in Information Technology offer vast opportunities to create, store, transmit and analyse data on symptoms, treatment options, medication prescribed, side effects and costs. Every government seeks to rationalise the cost of health delivery as they face high expectations of citizens and an increasingly ageing population. Detailed information is an important tool for governments in their search for a health system based upon highest value added. There are, at present, significant differences in national health expenditure of EU Member States. Some are seeking to establish partnership with Health Insurance companies that will make use of such advances in IT to achieve substantial savings.

Therefore the EU requires appropriate legislation to regulate the e-commerce in medicines. Safeguards on privacy, authority and validity of consultation, accuracy in dispensing of prescription and verification of the patient on delivery are only some aspects requiring new technical solutions. Appropriate EU guidelines must be established for availability of detailed information on chemical constitution of medicines, efficacy, toxicity, contraindications, dosage availability and cost that can be readily accessed on the internet by both patients and doctors.

Increasing mobility within the EU, rising aspirations of our citizens for better health leading to higher expectations of quality treatment and an ageing population will require substantial national expenditure on health services. European pharmacists must adapt quickly to advances in technology so that they remain an essential link in the chain of professionals required to deliver the best for our citizens!