Standing together for fairness and transparency – a pharmacist's call to action

It’s hard for me to believe it has been a couple of months since my last blog. I’ve been extremely busy with work projects, but I was able to sneak in a full 2-week vacation to Florida for the first time in many years. That’s certainly a big checkmark in the employee vs. employer column!

I owe you all an update on my specialty pharmacy project and I promise I’ll cover that in a future blog, but for today I have a different bee in my bonnet.

The Canada Health Infoway PrescribeIT® End Use License Agreement (“EULA”).

I’m a fan of e-prescribing, but I have all kinds of questions about the PrescribeIT® agreements from Health Infoway.

First, allow me to declare my own conflict of interest. I am currently an Alberta Pharmacists’ Association (RxA) board member and I have submitted my nomination package to run for my second term on board. I am in possession of a legal opinion on the EULA that was requested by RxA and which was recently made available to members. I am currently an employee of Neighbourly Pharmacy. I am writing this blog in my personal capacity, and my opinion is my own, not necessarily that of RxA or my employer. I have no formal legal training and my opinion should not be relied upon by any reader when deciding on whether to sign up for PrescribeIT®.

I support fair treatment for all stakeholders, for transparency in discussions, and for finding consensus among all parties at a table. It’s my opinion that Health Infoway has failed spectacularly to meet these criteria, although I’ve been attempting for several years to provide my feedback to them through various committees and channels that I have interacted with. I’ve never seen anything like it!

Pharmacy owners are presented with a Participation Agreement and the EULA and are told there are medical clinics “near” their pharmacy which are interested in using PrescribeIT. Various banners and pharmacy management software platforms have been quick to add fuel to the messaging. The not-so-subtle subtext is, “Hey…you don’t want to miss out if the clinic in town takes part. Even worse, you don’t want the 'other guy' down the street to sign on and have a competitive advantage when they get the e-prescription sent to them.”

Those of you who know me know I tend to read the fine print before I sign a document. In my non-legally trained mind, the fine print set off all kinds of alarm bells. It appeared to me that the stakeholders were not equally (fairly) sharing in the future fees and costs, including being prohibited from passing any costs along to patients; that pharmacies were being asked to indemnify Health Infoway against any future claims arising out of their use or access to PrescribeIT; and that the Agreement may be cancelled at any time by Health Infoway in its sole discretion, without notice, potentially putting the user offside of its legal and ethical obligations.

That’s why I was so relieved when RxA, which has been trying valiantly to provide feedback to Health Infoway (without much in the way of results) obtained a strongly informed legal opinion from Gerald Chipeur, Q.C., a well-respected public policy partner at Miller Thomson LLP.[1] In addition to many of my concerns, Mr. Chipeur went further to highlight that the structure of Health Infoway itself places Deputy Ministers (federal or provincial) in a conflict of interest and that the rollout of PrescribeIT across Canada contravenes the Conflict of Interest Act.

I’ll reiterate my earlier remarks. I support fair treatment for all stakeholders, for transparency in discussions, and for finding consensus among all parties at a table. While I would be hard pressed to find many pharmacists who would not agree it is time to do away with 1980s fax technology and embrace e-prescribing, I don’t believe there is consensus among stakeholders that the current EULA and Participation Agreement are fair and balanced.

I’m prepared to lead a discussion among pharmacy owners from Alberta, or across Canada, to improve the EULA and Participation Agreement. I’d like to address our common concerns directly with Health Infoway. If you are interested in supporting such an effort, then please provide me with your contact information by emailing [email protected] . This email address is personal to me. If you are a member of RxA, you should request a copy of the legal opinion by emailing Matt Tachuk at RxA [email protected]. I will do my best to move the discussion forward.