The incredible shrinking Big Blue Book

Canadians spend $20 billion on pharmaceuticals every year, making it the second-largest cost in the health-care sector. Helping practitioners access the most current information to make therapeutic decisions for patients can save money — and even lives.

Vioxx, a COX-2 inhibitor for arthritis,

was pulled off the market last year after research showed it could increase the risk of heart attacks and strokes. Celebrex, another COX-2 inhibitor, made the news when health officials announced they had received 100 reports of adverse reactions to the drug, including 14 deaths.

In January 2003, the Canadian Pharmacists Association (CPhA) received funding from Health Canada’s Primary Health Care Transition Fund, which supports “”renewal”” projects in the health-care sector. The CPhA’s e-Therapeutics initiative includes developing an online portal for access to current drug and therapeutic information, which will eventually be downloadable to PDAs.

“”If you can look at ways to improve outcomes for patients, improve efficiencies in prescribing and reduce errors in the system, you can save a lot of money,”” says Dyan Tufts-Conrad, health information specialist with the CPhA in Ottawa. “”What we’re building is a system that’s looking to move toward that.””

Subscription-based model

e-Therapeutics will be available to health-care practitioners in Canada, including physicians, pharmacists, nurses and dentists, through a subscription-based model (the system will eventually be able to pay for itself). It will provide drug and therapeutic information from the CPhA, as well as external links to information such as drug costs and coverage, adverse drug reactions, and warnings and advisories from Health Canada.

“”There’s a lot of situations where confusion over drugs can lead to negative consequences for patients,”” says Terry Lister, a partner with IBM Business Consulting Services’ Human Capital Management.

Over the years, the CPhA has amassed a vast amount of knowledge, contained in its Compendium of Pharmaceuticals and Specialties. “”They had an encyclopedia-like book, the Big Blue Book,”” she says. “”It was like four telephone books thick.”” If physicians were debating between two drugs, this was the book they’d turn to. As life got more complicated, the book got thicker.

“”They had this body of knowledge but it was still in book form and the Web seemed like a natural channel,”” says Lister.

The concept behind the portal is to make it easier to access rich, complex knowledge, she says, following a practitioner’s thought process. “”You might go in and say, ‘arthritis,’ and you have a chain of choices, or you might go in with the name of a drug but you want to know what an alternative drug would be.””

The CPhA ran a pilot of e-Therapeutics from November to January with 600 health-care practitioners.

The second phase of the project, which is now in progress, involves making some of that content available on PDAs. It’s also planning to develop a drug interaction analyzer and enhance the search functionality of the portal, says Tufts-Conrad.

The third phase, which will wrap up in March 2006, involves integration with physician clinical office systems, pharmacy software systems, Canada Health Infoway and provincial health informatics initiatives such as electronic medical records and e-prescribing applications.

“”If you’re going to make it visible on a PDA, you have to think about how much you can put on a two-inch by three-inch screen,”” says Lister, “”and yet in consultation with the practitioners, many of whom don’t sit at a desk all day, making it accessible on PDAs became an important step in the evolution [of the portal].””

There are a number of challenges when moving content from a traditional view to one that includes mobile technology, says David Senf, program manager with IDC Canada.

“”The first challenge is being able to integrate that content in such a way so you can in fact view it in one place,”” he says. There are additional challenges in taking that content and moving it onto mobile devices. “”One is being able to deploy mobile middleware so that you can take the content and translate it into a meaningful format for users of a PDA,”” he says. “”Another one of the big challenges is the security of that content.””

Organizations are starting to migrate to XML, which allows them to more easily deploy content across multiple form factors, he says.

“”It’s getting content into that XML format that is a challenge,”” he says, “”and you have to weigh the cost of migrating the data into an XML format versus the actual value that you’ll reap from having that.””

In the health-care sector, that value is easy to define. “”How many accidents do you have to prevent before you’ve earned the return on this?”” says Lister.

“”From a Health Canada point of view, it fosters more up-to-date knowledge in the hands of physicians and helps to ensure that Canadians have the best access possible to good pharmaceutical therapies.””

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Jim Love, Chief Content Officer, IT World Canada

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Vawn Himmelsbach
Vawn Himmelsbach
Is a Toronto-based journalist and regular contributor to IT World Canada's publications.

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