MARCH 2011

PRSRT STDUS POSTAGEPAIDTALLAHASSEE, FLPERMIT NO. 801

The Official PublicationOf The Florida Pharmacy Association

Battle Wages On OverImmunIzatIOn regIstrIes

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M A R C H 2 0 1 1 | 3

VOL. 74 | NO. 3MARCH 2011tHe OffiCiAL pubLiCAtiON Of tHefLORidA pHARMACy AssOCiAtiONP H A R M A C Y T O D A Y

florida

Departments 4 Calendar

4 Advertisers

5 president’s Viewpoint

7 executive insight

23 buyer’s Guide

Featuresthe pros and Cons of immunization Registries and the impact on providers and patients

121st Annual Meeting and Convention

fpA Officer and director Nominations

9

17

21

Shape the Future of Independent Pharmacy

Leverage the collective strength of thousands of independents and benefit from...

…Managed care that drives PBM recognition …Branding that drives consumer recognition …In-store execution programs that drive manufacturer recognition …Community advocacy that drives industry recognition

Join Health Mart today!Visit www.healthmart.com

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E-MAil youR suggEstions/idEAs to

dave@fiorecommunications.com

mission statements:of the florida pharmacy today JournalThe Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Phar-macy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the florida pharmacy today board of directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and execu-tive editor of the Florida Pharmacy Today Journal in the establishment and interpreta-tion of the Journal’s policies and the manage-ment of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the Journal in its goal of self-support.

advertisersCerner etreby ............................................ 24ePC ....................................................................... 6HealtHCare Consultants ....................... 3KaHan ◆ sHIr, P.l. ........................................ 13MCKesson ......................................................... 2PPsC ................................................................... 10rx relIef ......................................................... 13

2011

FPa Calendar MARCH

15-16 Pharmacist Days at the Legislature

16 Pharmacists Health Fair at Florida's Capitol

19-20 FPA Council and Committee Meetings

25-28 APhA Annual MeetingSeattle, Washington

ApRil

9-10 FPA Law ConferenceTampa, Florida

12-13 Board of Pharmacy Meeting, Jacksonville, Florida

22 Good Friday, FPA Office Closed

MAy

1-3 Pharmacist Mutual Leadership Conference

6 Legislative Session Ends

14 Law and Regulatory Continuing EducationJacksonville

23-25 NCPA Legislative ConferenceWashington, DC

30 Memorial Day, FPA Office Closed

JunE

7-8 Board of Pharmacy Meeting Ft. Lauderdale

22 - 26 FPA Annual Meeting and Convention Aventura, Florida

July

4 Independence Day FPA Office Closed

30 Legislative Committee MeetingOrlando, Florida

CE CREdits (Ce cycle)the florida board of Pharmacy requires 10 hours lIVe Continuing education as part of the

required 30 hours general education needed every license renewal period.Pharmacists should have satisfied all continuing education requirements for this biennial

period by september 30, 2011 or prior to licensure renewal.*for Pharmacy technician Certification board application, exam Information and study

materials, please contact ranada simmons in the fPa office.for More Information on Ce Programs or events:Contact the florida Pharmacy association at (850) 222-2400 or visit our Web site at www.

pharmview.com

ContACtsfPa — Michael Jackson (850) 222-2400fsHP — Michael McQuone (850) 906-9333u/f — Dan robinson (352) 273-6240faMu — leola Cleveland (850) 599-3301nsu — Carsten evans (954) 262-1300

disClAiMER articles in this publication are designed to provide accurate and authoritative information with re-spect to the subject matter covered. this information is provided with the understanding that neither florida Pharmacy today nor the florida Pharmacy association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. the use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

For a complete calendar of events go to www.pharmview.com

M A R C H 2 0 1 1 | 5

As your president, I have trav-eled throughout the state at-tending functions on your

behalf. I have spoken to many phar-macists about what is troubling them about our profession. Many are com-plaining about their current jobs, and that is not the way it used to be. The recent recession has brought many changes in our pharmacies statewide. Companies have to make a profit to survive, and they have made many changes in the way we practice our profession.

Some changes have been good and others are not. New technologies and automation have been used to free up more time for the pharmacist to do oth-er things. Pharmacists are now talking more to patients and providing immu-nization services. Some pharmacists have told me that management has cut back on their supportive help and they have to work more than ever before.

I have been asked about what the FPA is doing about these new issues. First of all, most of the pharmacists asking for our help are not FPA mem-bers. The FPA does not work on em-ployer issues and can only help our profession in the way we practice phar-macy. There are over 25,000 in-state li-censed pharmacists in our state, and only about 2,000 of them are members of the FPA. When we go to the Florida Legislature and advocate for our pro-fession, the question will always come up of how many pharmacists we repre-sent. With a membership of less than 10 percent, it is amazing that we can get anything done for the betterment of our profession.

This legislative session, we are mon-itoring and advocating for several

things that our members have found important for them in their practices. One of them is expansion of our immu-nization authority (HB585). Many pa-tients have been asking for other vacci-nations after we provide them with the flu vaccine. Many have asked for pneu-monia, herpes zoster and others. Also,

intern pharmacists are currently not al-lowed to provide this service. We feel that they should be able to provide this service as well.

The current law requires us to have an Epi-Pen available in case of an al-lergic reaction to the Flu vaccine. But, the current law does not allow us to administer this injection. How can a person who is experiencing an aller-

gic reaction self-administer this epi-nephrine? The FPA is advocating for this expansion of our authority to in-clude all of this. There is some opposi-tion for this expansion of our immuni-zation authority, and we need support from all pharmacists who have an in-terest in this.

We are also looking at MTM servic-es to continue to be provided by phar-macists and are monitoring several bills that may affect our profession. The Legislature is looking at the state bud-get and trying to make cuts and chang-ing the way things are. It has been sug-gested that the Medicaid program go to the HMOs for administration, and we are advocating that any willing pro-vider pharmacy is included in this net-work.

We also support the “My Script My Choice” social media campaign at the www.myscrpitmychoice.com website. We have support from the Florida Inde-pendent Pharmacy Network and PPSC

More Members Means More Influence at the Capitol

When we go to the Florida Legislature

and advocate for our profession, the question will always come up of how many pharmacists

we represent. With a membership of less than 10 percent, it is amazing that we can get anything done for the betterment of

our profession.

the President’s viewpointguEst ColuMnist suzAnnE KEllEy, BpHARM, CpH

Humberto Martinez, 2010-2011 FpA president

6 | f L O R i d A p H A R M A C y t O d A y

See "Viewpoint", continued on page 14

for this campaign. The state employees now have to get their refills by mail or-der or a PBM pharmacy for their medi-cations, and some pharmacies have lost longtime patients to this program. If any of this things interest you, then be involved in your professional associa-tion and help make a difference.

We just had the Miami Pharmacists Health Fair, and it was even more of a success than last year. The FPA has a large booth at this event and we pro-vide health screenings for over 2,000 at-tendees. We again had the most pop-ular health screening with the bone density machine, with over 110 people screened. Our Cholestech machine was used for over 30 people that had high levels in the preliminary check with the Cardio Chek machine used by the stu-dent nurses. We also provided blood pressure monitoring and MTM services from our pharmacist at the booth. We estimated that we saw over 300 people at our FPA booth. I would like to thank NSU for providing the screening ma-chines for this event.

The Tallahassee Pharmacists Health

Fair and Legislative Days are coming up this month. We have over 160 peo-ple registered for this event, and we hope that this will be a great success. The chair of our Public Affairs Council, Suzanne Kelley, has been coordinating this event. Her council has been work-ing hard on the logistics for this health fair. I know that it will be a great suc-cess and better than last year. This year the FPA and FSHP have collaborated to make this program successful. The pharmacists and students provide a multitude of health screenings.

We are providing blood pressure monitoring, glucose, lipid, bone density, body mass composition, and dermato-logical screenings. Cardiac risk assess-ment and MTM services are also pro-vided. If any members are interested in helping us with this event, feel free to contact us and volunteer for the health fair next year. The legislators who at-tend this event are sometimes surprised that pharmacist can provide this ser-vice.

We also have legislative visits coor-dinated by our lobbying firm Prieguez

and Weems. Here is where the phar-macists and students can make a dif-ference in the things that we are advo-cating for the profession of pharmacy. Talking points and appointments will be provided for all those attending this event. We are also looking at having a pharmacist on call for every week of the legislative session. We are the only health profession that has not done this at all. If you want to volunteer your time to be in Tallahassee during a week of the legislative session, please contact our FPA office. This is where our mem-bers can be very helpful to our profes-sion.

We have also been contacted by sev-eral members who have had a negative audit from some PBMs using current Florida law. An example of one of these is that current law states that needed in-formation must be on the FACE of the prescription. If your pharmacy system prints a label with the needed informa-tion and you place this on the back of the prescription, then you are not fol-lowing current Florida law and the au-

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M A R C H 2 0 1 1 | 7

One major challenge that we overcame

was legislators’ initial inclinations that

pharmacists are nothing more than pill counters

and dispensers.

Prevention, prevention, preven-tion! Prevention is a word that is attracting much attention among

today’s health care providers and pol-icy makers, as disease prevention is a top priority in all professions across all fields in our health care system.

The term “prevention” embodies a wide scope of meaning, from promo-tion of a healthy lifestyle to early de-tection and diagnosis of medical condi-tions. Which area of prevention are we, as pharmacists, involved in and how can we become more active within our community to ensure prevention of dis-ease? The administration of vaccines, such as the influenza vaccine, plays a crucial role in preventing the spread of many diseases.

For the past three years, Florida pharmacists have been successful in administering the influenza vaccine. In 2007, a law was passed that allowed pharmacists in Florida to administer the influenza vaccine to adults. Howev-er, before that law was passed, pharma-cists had to overcome some harsh criti-cism and tough challenges. One major challenge that we overcame was legis-lators’ initial inclinations that pharma-cists are nothing more than pill coun-ters and dispensers. One could assess that the Florida legislators have the wrong diagnosis of the impact a phar-macist has on patient care. Therefore, concerned pharmacists, the Florida Pharmacy Association, and other im-portant groups, worked collectively to educate those at the Capitol.

Their main focus was to make it clear that pharmacists play a vital role in drug therapy management. This man-agement includes, but is not limited to, drug utilization review, drug-drug in-

teractions, review and monitoring of drug therapies through interpretation of laboratory values, and communica-tion with prescribers to ensure that pa-tients receive the proper medication at the safest and most effective dose for the proper length of time.

Another educational point was that pharmacists in other states across the nation were allowed to vaccinate and have done so successfully. After almost

10 years of active advocacy, the bill was finally passed in 2007, allowing Florida pharmacists to administer the influen-za vaccine. Since its passing, millions of flu vaccinations have been adminis-tered by trained and certified pharma-cists in Florida and no major adverse events have been reported.

Not only has this had an impact on health care costs, it has prevented the spread of the flu virus and prevented death among those who are most vul-nerable within the communities they serve — something you cannot put a price tag on. The positive impact phar-

macists have had thus far while hav-ing the authority to administer the flu vaccine in Florida brings a question to mind: Why should pharmacists be lim-ited to the administration of only the in-fluenza vaccine?

During Florida’s 2011 legislative ses-sion, which began this month, a new bill has been proposed to amend the current law that allows Florida phar-macists to administer the flu vaccine. If passed, this bill would add Pneumo-coccal and Varicella Zoster vaccines to the list of vaccines that a certified phar-macist can administer. Also included in this important bill is supervised phar-macy intern vaccine administration, as well as epinephrine administration via an autoinjection delivery system as epi-nephrine is an important part of a vac-cination protocol in case of anaphylactic reactions to any vaccine administered. These diseases can be devastating to the public and are completely prevent-able.

Florida Pharmacists - Take Action for Prevention

executive InsightBy MiCHAEl JACKson, RpHguEst ColuMnist, AndREw MEgnA, pHARMd CAndidAtE, 2011

MiCHAEl JACKson, FpA ExECutivE viCE pREsidEnt/CEo

Andrew Megna, pharmd Candidate, 2011

8 | f L O R i d A p H A R M A C y t O d A y

Executive Vice President/CEOMichael Jackson

(850) 222-2400, ext. 200Director of Continuing Education

Tian Merren-Owens, ext. 120Controller

Wanda Hall , ext. 211Membership CoordinatorRanada Simmons , ext. 110

Educational Services Office AssistantStacey Brooks , ext. 210

FloRidA pHARMACy todAy BoARdChair..................................Betty Harris, Lighthouse Point Vice Chair ................................. Jennifer Pytlarz, BrandonTreasurer ..............................Stephen Grabowski, TampaSecretary ........................Stuart Ulrich, Boynton BeachMember ................Don Bergemann, don@bceinfo.comMember .................................... Joseph Koptowsky, MiamiExecutive Editor ........Michael Jackson, TallahasseeManaging Editor ........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2011, FLORIDA PHARMACY JOURNAL, INC.

ARTICLE ACCEPTANCE: The Florida Phar-macy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today.

The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board.

FLORIDA PHARMACY TODAY, Annual sub-scription - United States and foreign, Indi-vidual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax.

Florida Pharmacy association

610 N. Adams St. • Tallahassee, FL 32301850/222-2400 • FAX 850/561-6758

Web Address: http://www.pharmview.com

FPa staFF Pneumococcal disease kills more people in the U.S. each year than any other vaccine-preventable disease.¹ The CDC estimates that there are nearly 1 million cases of shingles in the U.S. each year, and almost half of the patients are older than 60 years of age.² Florida has one of the largest populations of elder-ly people in the nation, and this number continues to grow. With this in mind, it is necessary to have access to trained health care professionals to meet the needs of our growing elderly popula-tion.

The elderly population is already saddled with countless doctor appoint-ments and other obligations to ensure that their health status remains up to par. Patients often go to the doctor when they are healthy just to learn that their doctor may not have the vaccine in stock or does not administer a certain vaccine due to low reimbursement from third-party payers; meanwhile, the local pharmacy down the street is more than willing to meet this need.

Unfortunately, under the current law, the pharmacist cannot provide such care. This is an injustice to those seek-ing adequate health care. Having ac-cess to vaccinations at a local pharma-cy where people more than likely pick up their medications, not only ensures a high quality of care, but also adds to a pharmacist’s multi-disciplinary role as a healthcare provider within their community. Out of all of the health care professions, pharmacists are the most accessible to the public. A pharmacy can be found on almost every corner of Florida, including those rural and un-derserved areas, and, in most communi-ties, the pharmacist is available 24 hours a day with no appointment necessary.

Anne Schuchat, M.D., the assistant surgeon general and the director of the National Center for Immunization and Respiratory Disease, recently wrote in a letter to the American Pharmacist As-sociation that, “Pharmacists, working with the public health community, can assist our nation in meeting its major public health challenges.”³

Pharmacists who are active in the role of immunizer can have a tremen-dous impact on the challenges we face in preventing the spread of communica-

ble diseases. Today, according to APhA, all 50 states have granted pharmacists the right to administer vaccines under certain conditions, which vary from state to state. Thirty-eight states allow pharmacists to administer any vaccine, and just three states, including Flori-da, allow them to administer only the flu vaccine. Pharmacists in Florida are trailing behind the nation in our state-wide health care system, but we should be leading. If passed, the proposed bill to amend and add the Pneumococcal and Varicella Zoster vaccines to the list of services that pharmacists and super-vised interns can provide the public will be a giant step in the right direction to provide higher quality of care for all Floridians.

An increase in the number of admin-istered vaccines because of the accessi-bility will result in reductions to health care costs, hospitalizations and death associated with these diseases. But this bill, along with subsequent bills associ-ated with our profession, will not pass if our state legislators do not hear our voices or the voices of our concerned pa-tients within the communities we serve. Every pharmacist in the state should take a moment to contact their state leg-islators via phone, letter or email and inform them about the importance and impact a pharmacist can have in pro-viding vaccinations to the public.

Dr. Michael Thompson, professor at Florida A&M University College of Pharmacy and Pharmaceutical Sciences once said, “Not getting involved in pub-lic health care policy empowers others to decide your future.” One voice can be heard next door, but a thousand voices can be heard in the Capitol. To ensure a high quality of care to every commu-nity in Florida and to positively impact the evolution of pharmacy practice, this bill must be passed.

1. http://www.vaccineinformation.org/pneumchild/qandadis.asp

2. http://shinglesinfo.com/what-is-shingles.html

3. http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacist_Immunization_Center1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=24387

M A R C H 2 0 1 1 | 9

ABstRACt

Background: Over the past twenty years, immu-

nization registry development and ex-pansion has occurred in the United States. The registry allows practitio-ners to input vaccine records into a da-tabase to document vaccine informa-tion. There have been many advocates for this transition to an electronic sys-tem; however, some downfalls have been identified. The primary objective of this review is to evaluate advantages and disadvantages of the participation in and usage of immunization regis-tries throughout the healthcare system, further focusing on the pediatric popu-lation of Florida.

Methods: A literature search was conduct-

ed through five databases: MEDLINE, EMBASE, International Pharmaceuti-cal Abstracts (IPA), MDConsult, and Google. Search terms included immuni-zation registries, immunization information systems, vaccines, vaccine registry, immu-nization programs, and Florida SHOTS.

Results: We compared benefits and limi-

tations of selected publications. For many patients, this immunization reg-istry will provide easy access to their vaccination records. With over 12 mil-lion practitioners registered in the state of Florida, 6,000 of their patients are enrolled in the database called Flori-da SHOTS. Most results pertained to a specific subset of the pediatric popula-tion, while other age groups were not represented in the literature.

Conclusion: The pros and cons of immuniza-

tion registries have to be assessed by providers so that biased decisions will be kept to a minimum. Practitioners should find ways to overcome the lim-

itations associated with registries for the benefit of patients. The use of Flor-ida SHOTS has allowed the state to be inter-connected into one database, however the registry still requires con-stant vigilance by active participation from providers. If practitioners take the initiative to participate in these reg-istries, it may significantly contribute to the prevention of certain diseases and duplication of vaccinations. Further re-search should include all age groups while also including the role of phar-macists in immunizations.

Background Immunization registries are defined

as confidential, population-based com-puterized systems for maintaining in-formation regarding children’s vaccina-tions.1 Over the past several years there has been an increase in use of these computerized databases throughout the United States.2 These databases have helped increase the vaccination rate in the U.S. from 76% in 1997 to 80% in 2007 for children 19-35 months of age.2, 3 This technological advancement is a way in which practitioners keep track of pa-tient’s vaccines and also allow patients to have a record of their vaccine history.

Immunization registries have been established in all 50 states, and yet no state has fully utilized this system to its maximum capacity.1,4 Immunization registries are often developed by state funded programs and each state has one or more computerized registries for their geographical location.5

In 1974 Delaware became the first state to create a population-based reg-istry for managed care. Throughout the 1980s, the use of registries was not ful-ly implemented for vaccine documen-tation. It wasn’t until the next decade (1991) that advancements in the use of immunization registries occurred, due largely to a program initiated by the Robert Wood Johnson Foundation known as All Kids Count. This program

the Pros and Cons of Immunization registries and the Impact on Providers and Patients

Shirin Abdel-Jawad, Student Pharmacist

Dalita Bouchakjian, Student Pharmacist

Marianne Mallouh, Student Pharmacist

N. Megan Sadoughi, Student Pharmacist

Faculty mentor:Nancy Borja-Hart, Pharm.D., BCPS (corresponding author)Assistant Professor

Nova Southeastern University College of Pharmacy3200 S. University Dr. Ft. Lauderdale, FL 33328Work (954)262-1372Fax (954)262-2278

Disclosure statement: There are no conflicts of interest to report.

Acknowledgments: We would like to thank Donald Lawler, Medical Health Care Program Analyst for Florida SHOTS Pro-gram, Bureau of Immunization, Florida Department of Health, for interviewing with us about the Florida SHOTS program and An-gela Garcia, Pharm.D. for her care-ful review of this manuscript.

10 | f L O R i d A p H A R M A C y t O d A y

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granted funds to initiate registries. Lat-er, in 1993, funds from the federal gov-ernment were put into place, support-ed by President Bill Clinton, to develop the Childhood Immunizations Initia-tive, which allowed resources to be channeled to required state run regis-try programs. The Centers for Disease Control and Prevention’s (CDC) Na-tional Immunization Program also pro-moted the development of these regis-tries. In the late 1990s, states started to further develop and require comput-erized vaccine registries for practitio-ners.1

The prevention of disease is one of the primary goals of the U.S. health care system.4 The relevance of these programs is to help prevent or erad-icate diseases, like measles, chicken pox, rubella, and others. Registries are essential in increasing immunization coverage rates.1 Over the past years, es-tablished registries have helped to in-crease immunization rates.3 One goal of Healthy People 2020 is to increase the proportion of children under age

6 years who participate in fully opera-tional population-based immunization registries.6

Studies have shown that immuni-zation information systems have many benefits and limitations in their appli-cation. The benefits of immunization information systems include reduc-ing duplicate vaccinations and sav-ing time.7 Health practitioners contin-ue to have frustrations with registries, some of which include training, data entry and software problems.1 It has also been shown that there have been missed opportunities to immunize be-cause records have been incomplete or providers do not have access to infor-mation at the time of doctor’s office vis-it.2 It has been reported that with the proper use of immunization informa-tion databases, patients appreciate the extra effort and choose to participate in the programs.8

In the state of Florida, vaccines are required for entry into daycare, camps and schools.4 Florida SHOTS, estab-lished in 2000, began actively enter-

ing birth records in January 2003.9 Cur-rently, Florida SHOTS has 12 million providers registered in the database.10 Through this database, registered pro-viders can enter patient’s vaccine infor-mation. In order for practitioners to use this system, they must sign up and reg-ister with the program which is known to be “fast, easy, and free.” Once the practitioner implements this program in their practice, it is their responsibil-ity to inform their patients of this of-fer. From the Kaiser Family Founda-tion website, 82% of children ages 19-35 months in Florida are immunized as compared to the national average of only 78% (data reported for 2008).3 Flor-ida is surpassing the national average, but with the implementation of Florida SHOTS it is hoped that this percentage will increase further.9

The use of computerized immuniza-tion registries has the potential to im-pact several aspects of health care. Pro-viders, patients and the health care system as a whole benefit from hav-ing this organized database, however,

M A R C H 2 0 1 1 | 11

many obstacles still stand in the way of its full execution. The purpose of our literature review is to report the ad-vantages and disadvantages of having an immunization information system and how registries influence the over-all healthcare system in regard to physi-cians, pharmacists and patients in Flor-ida.

MethodsA literature search was conduct-

ed through five databases: MEDLINE, EMBASE, International Pharmaceuti-cal Abstracts (IPA), MDConsult, and Google. Search terms included immuni-zation registries, immunization information systems, vaccines, vaccine registry, immuni-zation programs, and Florida SHOTS.

REsults

Benefits of Registries Immunization registries were devel-

oped to record administered childhood immunizations, track immunization coverage, generate reminders when im-munizations are due, assure safety and accuracy to prevent over-immuniza-tion, and track post effects of vaccines. Immunization registries are defined by the National Vaccine Advisory Com-mittee (NVAC) as being, “confidential, computerized information systems that contain information about immuniza-tions and children.” 8 The key point of this definition is that immunization re-cords are to be kept confidential.

Using immunization registries also helps immunization timing due to the complexity of these schedules. Vaccine scheduling helps to keep track of pa-tient history and new requirements of immunizations. Accurate immuniza-tion scheduling will allow patients to keep track of their schedules and will ultimately allow them to save time and avoid frustrations.8

Cost is a factor that can affect partic-ipation in immunization registries, but in the long run, cost is ultimately insig-nificant.1 Overall, costs are minimal (en-rollment is free) and the outcomes have proven to be cost-effective.

One study in which parents’ opin-ions were taken into consideration about immunization registries found

that parental support for registries was high, despite their unawareness of the immunization registries’ existence.8 In this study, it was found that a majority of parents in four different states (Col-orado, Massachusetts, Missouri and Washington) were supportive of laws that mandated providers to report to registries.

One of the benefits of immunization registries is the efficiency in the deliv-ery of services. Efficiency of computer-ized systems is superior to the time con-suming paper system. Computer-based immunization registries are highly effi-cient in terms of saving time, prevent-ing future disease states and preventing duplication of vaccines.1

There are benefits for the pharma-cist’s participation as well. These in-clude involvement in direct patient care, less paper work and possible re-imbursement depending on corpo-rate policies. Through these immuniza-tion registries, the acknowledgment of pharmacy as a profession has been rec-ognized by other health care providers and patients.

Florida SHOTS offers many benefits to pharmacists through a simple system in which it links the existing billing and practice management to the statewide immunization registry. It is convenient for pharmacists and many healthcare professionals as well as time saving and efficient in minimizing the manu-al search of paper files. This system al-lows for records to be accurately report-ed to registries, since this is mandated by law. These interconnections with-in the immunization registry database allow access to the physician’s offices, managed care organizations and other health systems. The major benefits that immunization registries offer, accord-ing to Florida SHOTS, are quick access to a child’s immunization status and computer-generated reports that are ac-cepted by schools, daycares and camps as valid documents.

drawbacks of RegistriesThere are factors that limit the use of

immunization registries. It was found that parents tend to follow their physi-cian’s advice regarding participation in immunization registries.8 Parent’s par-

ticipation in those registries is highly affected by the physician’s opinion of registries. Therefore, when physicians don’t participate in immunization reg-istries, parents are less likely to partici-pate in the registry as well.

Another major limitation seen with immunization registries is who should pay for them. From the day of its devel-opment, registries have been financial-ly supported by federal funding, state funding, local funding, private founda-tions and some managed care organiza-tions.1 The majority of the costs of these registries were associated with the de-velopment of the electronic data system and its technical feasibility. According to NVAC, more contributions should be made by those who benefit from im-munization registries, including health care providers, vaccine manufacturers and patients.8

In addition, some technical limita-tions are associated with the use of im-munization registries. For example, any system that is slow or difficult to use will not be accepted in clinical settings, especially retail pharmacies or busy pe-diatric centers with high patient vol-umes and limited time. Even with the presence of electronic accuracy, some entry error by personnel could occur.

Approximately 75% of children less than 6 years of age still need to be in-cluded in an immunization registry in order to meet the national health ob-jective.5 Provider participation in pub-lic practices was higher than participa-tion in private settings. This is an issue because more immunization services are shifting away from public sectors. In 2000, it was evident that four major issues may affect immunization par-ticipation and development, including ensuring privacy and confidentiality, encouraging provider’s participation, dealing with technical and operational difficulties and determining resources to develop and maintain registries.5

Florida SHOTS has several pitfalls. For providers these include the time and cost of training personnel and loss of productivity as a result of the train-ing.9 Patients might also be concerned with confidentially issues that may come up as a result of information in-put. Florida pharmacists are limited in

12 | f L O R i d A p H A R M A C y t O d A y

the use of Florida SHOTS, specifically for pediatric patients because they can-not provide vaccinations for adolescents at this time.

discussionThe purpose of immunization reg-

istries was established by NVAC in or-der to introduce registries to health care professionals. By doing so, many pro-viders are better able to understand the application of these registries to their patients. In making use of these regis-tries, participants in the health care sys-tem (both patients and providers) are able to take advantage of these useful resources.

impact on providersProvider participation in the regis-

try is a requirement that must be met to ensure its success. In a practice set-ting such as pediatric health care cen-ters and retail pharmacies, lack of time is always an issue. Immunization reg-istries provide a time-saving program in which access to records is easily ob-tained. It is easy to identify immuni-zations that are needed and avoid du-plications of vaccines during health checkups. The program allows for au-tomatic notifications to providers which in turn alert parents when immuniza-tions are due.

When developing and operating im-munization registries, cost can be an issue. A fully operational population-based registry will offset many oth-er costs in the long term. Avoiding the cost of duplicate immunizations, lim-iting the cost of missed appointments, preventing diseases or hospitalizations are just some of the long term benefits offsetting the issue surrounding the im-mediate costs.5 Financial support of im-munization registries continues to be a major debate. In order for these im-munization registries to succeed, health care providers, vaccine manufacturers and even patients must also provide funding. More funds and resources must be dedicated to improve the exist-ing immunization registries and gener-ate new ones.

Computerized records, when com-pared to manual records, allow health care providers to save time.9 Electron-

ic records are more convenient due to the increased amount of data that needs to be processed. The software for these registries is specifically designed to al-low more precise and easier access of vaccination information. However, these systems can be slow or difficult to use, which discourages health care pro-fessionals from continual use. Techni-cal software problems can be reported to the registries’ help desk and are ad-dressed on a regular basis.10 Therefore, immunization registry databases, such as Florida SHOTS, should request feed-back from different healthcare provid-ers. Furthermore, technical and oper-ational challenges can be barriers that limit the efficient use of immunization registries. To solve this problem there must be a standardized system to en-hance the communication between the central registry and participating pro-viders.

Immunization registries require min-imal software training for office person-nel. Training will take time and effort and will result in loss of productivity. On the other hand, the benefits in the long term will outweigh the loss of pro-ductivity during the training period.

impact on pharmacists Only certified pharmacists can im-

munize patients and enter immuniza-tion records into the database. Pharma-cists are mandated by law to document immunizations through an integrated database that is connected to the regis-tries. This linkage from a pharmacy to the registry allows the pharmacist to be an active participant in this health care process. Pharmacists will help protect patients’ privacy and ensure the confi-dentiality that is a major concern for pa-tients. In general, pharmacists can play a role in reminding patients to keep track of their immunization records by also advising them to inform their pri-mary care providers of these registries. In regard to the state of Florida and its computerized database, pharmacists can properly follow the Florida statute S. 465.198 which grants them access to forward information to the registry.9

impact on parentsParents can rest assured that privacy

of health documents are kept because these systems are designed to main-tain confidentiality. Access is limited to authorized health care personnel with password protected logins.9 Another is-sue for parents is the lack of a nation-wide, centralized system. It is important for parents to understand the benefit of keeping track of their children’s immu-nizations when moving from state to state, especially for schools.

ConclusionThe use of immunization regis-

tries is highly encouraged within the healthcare system. There is the poten-tial for growth of these types of pro-grams, which will lead to an increase in the accuracy of maintenance of im-munization records. In the pediatric population, it is fundamental that we assure patients’ safety by keeping up-to-date information available. Florida SHOTS was created for the convenience of health care providers and patients. Furthermore, Florida SHOTS is intend-ed to increase Florida’s immunization rates. Patients and caregivers should be aware of these immunization registries and have a proactive approach in main-taining their vaccination records. Pro-viders have a role in educating parents about these registries and ensure con-cerns are subsided.

Future goals of immunization reg-istries should include laws that practi-tioners must follow in order to use and sustain data registries. Since pharma-cists are eligible to be certified for vac-cine administration, it is vital that they actively participate in documenting im-munization records as well. This re-sponsibility is essential for the wellness of patients and will allow the profes-sion to expand. Studies should incorpo-rate the pharmacists’ input on these im-munization registries. In general, health care practitioners are already account-able for patient vaccine records in their daily practice, and registries will ame-liorate record keeping.

Conclusion Immunization registries can be com-

plex to manage and put into practice be-cause of several barriers. However, the benefits associated with immunization

M A R C H 2 0 1 1 | 13

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registries, which include computerized record keeping and time saving strate-gies, are reasons why both practitioners and patients should advocate for such registries. Immunization registries pro-vide a method of documentation, which will help increase patient adherence to recommended vaccine schedules. More studies are needed in order to assess how immunization registries can be successfully incorporated into practice for both pediatric and adult popula-tions. Studies should also be published on the significance of the pharmacist’s role in immunization efforts through registries. Overall, the benefits of im-munization registries could positively impact patient care and documentation in healthcare services.

References 1. Freeman VA, DeFriese GH. The

challenge and potential of childhood immunization registries. Annu Rev Public Health. 2003;24:227-246.

2. Wood D, Saarlas KN, Inkelas M, Matyas BT. Immunization registries in

the United States: implications for the practice of public health in a changing health care system. Annu Rev Public Health.1999;20:231-255.

3. Kaiser State Health Facts: Percent of children age 19-35 months who are immunized, 2008. Available at: http://statehealthfacts.org. Accessed August 3, 2010.

4. Center for Disease Control and Prevention: IIS States and Territories. Available from: http://www.cdc.gov/vaccines/programs/IIS/states-territories. Accessed January 29th, 2010.

5. Centers for Disease Control and Prevention. Progress in development of immunization registries --United States, 2000. MMWR Morb Mortal Wkly Rep. 2001;50(1):3-7.

6. Healthy People 2020: Objectives of Immunization and Infectious Disease. Available from: http://www.healthypeople.gov/HP2020/Objectives. Accessed January 29th, 2010.

7. Adams WG, Conners WP, Mann AM, Palfrey S. Immunization entry at the point of service improves quality, saves time, and is well-accepted. Pediatrics. 2000;106(3):489-492.

8. Linkins RW, Salmon DA, Omer SB, Pan

WK, Stokley S, Halsey NA. Support for immunization registries among parents of vaccinated and unvaccinated school-aged children: a case control study. BMC Public Health. 2006;6:236.

9. Bureau of Immunizations. Florida SHOTS. Available from: http://www.flshots.com Accessed January 29th, 2010.

10. Lawler, Donald. (2010, March 12). Telephone interview.

EXECUTIVE EDITOR’S NOTE: Dear readers of Florida Pharmacy Today. We generally try to get comprehensive ar-ticles reviewed however this particular article is of general interest to the mem-bership and is timely for publication in the Journal. The Journal does wish to express to the readers that the opinions and findings of this article’s content are those of the author and have not been evaluated. If you have expertise in a pharmacy practice discipline and you are interested in being a reviewer for the Florida Pharmacy Today please con-tact the FPA or the managing editor at (850) 222-2400 or (850) 668-0510

14 | f L O R i d A p H A R M A C y t O d A y

ditors will do a charge back for the en-tire prescription. There have also been some charge backs for prescriptions not written in an approved format un-der current law.

Current law states that all prescrip-

tions must have the month written out in text form not in number format. But, controlled substances prescrip-tions can have the month in abbreviat-ed text form and the quantity written out in text and number form. This law

allows the pharmacist to call the pre-scriber and correct the prescription so that it conforms to current law. Some of our members have had charge backs for this written format error. The FPA is working on correcting some of these outdated laws to conform to the cur-

rent practice of pharmacy.None of these things are easy to do

without the support of the licensed pharmacists in the state of Florida. We need more members so we can in turn, work more effectively for the pharma-

cists. We listen to our members, and with more members we should have more input as to what we need to change to make our profession one of the best that can ever be.

Thank you for your support for the last few months, and I am here to serve. n

Humberto “Bert” MartinezNone of these things are easy to do without the

support of the licensed pharmacists in the state of Florida. We need more members so we can in turn,

work more effectively for the pharmacists. Florida Pharmacy association law and regulatory

conFerence

Intercontinental Hotel4860 West Kennedy Blvd

Tampa, Florida 33609April 9 - 10, 2011

I nominate___________________________Philanthropist of the Year for his/her involvement in a

n Charitable organization/s that meets the criteria below: n Elaborate reason for nomination: motivation, enthusiasm n Membership/ serving as an officer, committee chair n Effort to inform community about organization n Community service project/s participation n Contributing factors of success with project/s n Speaking engagements

Please limit your typed submission to 3 pages.Send 4 copies to: Patsey J. Powers, Executive Vice PresidentFlorida Pharmacy Foundation610 N. Adams StreetTallahassee, FL 32302

noMinAtions now BEing ACCEptEd FoR tHE

FloRidA pHARMACy FoundAtionAlton towER pHilAntHRopy AwARd

The Florida Pharmacy Foun-dation is pleased to present this award in honor of Al Tower. Please follow all of the required criteria. The Selection Committee will re-view all applicants and make the final decision. Only the winner will be notified. There is a cash award of $500 presented to the winner’s choice of charity/ orga-nization and a plaque presented to the winner at the Annual Meet-ing of the Florida Pharmacy Asso-ciation Awards Night at The Fair-mont Turnberry Isle Resort & Club, Aventura, FL, June 25, 2011.

Deadline for submission is April 15, 2011

"Viewpoint", continued from page 6

M A R C H 2 0 1 1 | 15

Having Difficulty with electronic Prescriptions?As you know, E-prescribing is on the rise as more providers are tapping into this new technology to improve the safe-

ty, quality and efficiency of the prescribing process and take advantage of government incentives. We all hear from pharma-cists about noticeable errors and challenges they face with e-prescriptions. In fact, recent studies have shown that new e-pre-scriptions are twice as likely to require a pharmacist’s intervention as new written prescriptions. Thanks to a grant provided through the Community Pharmacy Foundation, in October the Alliance for Patient Medication Safety (APMS) re-introduced the Pharmacy and Provider e-Prescribing Experience Reporting (PEER) Portal (originally developed in collaboration with Sure-Scripts). The revised PEER Portal uses an enhanced, streamlined web-based questionnaire that enables pharmacies to easily en-ter information about e-prescribing challenges and experiences and provide their critical feedback and expertise to improving the e-prescribing process. If you are experiencing challenges with e-prescribing systems, please consider visiting this website: https://www.pqc.net/eprescribe/disclaimer.aspx and report your concern.

16 | f L O R i d A p H A R M A C y t O d A y

HELP SUPPORT THE ADOPT-A-STUDENT PROGRAM Florida Pharmacy Association

121st Annual Meeting & Convention June 22-26, 2011

The Fairmont Turnberry Isle Resort & Club – Miami, Florida

Again this year, students from Florida Colleges of Pharmacy will be “Adopted” for the FPA Annual Meeting and Convention. Pharmacy students will benefit from the interaction with practicing pharmacists, learn first hand how FPA actually operates and how they can become involved in their chosen profession. As you remember, college students are on a tight budget and most of them cannot afford to attend convention. Here is how you can help!

The cost to register/sponsor one student is $110.00. They also have travel, room and food expenses. Adopted students will receive complimentary registration, hotel accommodations and be able to attend special programs designed for them. If enough money is raised, FPA will also be able to include additional support for meals. Make a contribution yourself! Ask your local unit association or get together with friends to Adopt-A-Student. Remember…..these are the future leaders of pharmacy!

Mentor Program. Each of the adopted students will be assigned a pharmacist who will invite them to attend meetings, CE programs, and share their knowledge and pharmacy experience with them. If you plan to attend the convention and would like to be a mentor, please contact the FPA office.

Please fill out the form below and fax or mail with your check to: Florida Pharmacy Association

610 North Adams Street Tallahassee, FL 32301

Fax: (850)561-6758 Please make your check payable to the Florida Pharmacy Foundation

Sponsor Name:_________________________________________________________________________

Address: ______________________________________________________________________________

City: _______________________________________ State: __________ Zip:_______________________

Phone: ________________________________ Amount of Contribution:___________________________

Charge to the following (please circle): VISA MASTERCARD DISCOVER AMEX

Account #:_____________________________________Security Code:________ Exp. Date: ____________

Signature:________________________________________________________________________________

Yes, I would like to serve as a Mentor. Contact me with more information on Mentoring.

Contributions to the Florida Pharmacy Association Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details.

M A R C H 2 0 1 1 | 17

18 | f L O R i d A p H A R M A C y t O d A y

M A R C H 2 0 1 1 | 19

When: June 23, 2011

Where: Fairmont Turnberry Isle- Aventura, FL

Time: 7:00 P.M. - 10:00 P.M.

Cost: $50 per Person (You must be 21 years or older to attend)

A COPY OF THE OFFICIAL REGISRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

1,000 PLAYING CHIPS (Re-buy available)CASH BAR | LITE HORS d’OEUVRES | BIG PRIZES

FLORIDA PHARMACY FOUNDATION SPONSORS

Come and join your friends at Casino Night, glamorous evening of fun, playing Black Jack, Poker, Craps and the numbers game of Roulette. Big Prizes will be awarded.

The proceeds will benefit the goals of the Foundation to further the need of providing student scholarships, Adopt-a-Student program, Hardship Fund, Demonstration Project Grants and Alton Tower Philanthropy Award.

Florida Pharmacy Foundation | 610 N. Adams St, Tallahassee, FL 32301 | (850) 222-2400 | Fax (850) 561-6758

Payment Information Casino Night: $50 per person

Check enclosed for tickets, in the amount of $ made payable to the Florida Pharmacy Foundation

Please charge my: q Visa q MasterCard for tickets, in the amount of $

Card number Expiration date

Signature

Signature Printed

Name

Address

City State Zip

Work Phone Home Phone

PayPal available at www.flpharmfound.org

M A R C H 2 0 1 1 | 21

CAll FoR FpA oFFiCER And diRECtoR noMinAtions for 2012 Elections

The FPA By-Laws specify that any subdivision or any member in good standing may nominate one per-son for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The trea-surer shall serve a two year term and may succeed to one consecutive term of office in that capacity. Nomi-nees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for presi-dent-elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for trea-surer should have good analytical skills and experi-ence and ability in financial management and budget preparation.

There are nine regional Board Directors who shall serve two year terms. Nominees must be a Flori-da registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, Board Directors must be a member of at least one the FPA Unit Associations within their region. Board Directors terms are stag-gered such that even numbered regions shall be elect-ed in even numbered years and odd numbered re-gions shall be elected in odd numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annu-al meeting of the second ensuing year.

FPa CanDIDate nOmInatIOn FOrmI AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NAME:

ADDRESS:

FOR THE FOLLOWING OFFICE:(Nomination Deadline September 1, 2011)

q President-Electq Treasurerq Board Director Region 2 Region 4 Region 6 Region 8

NOMINATED BY:

NAME:

DATE SUBMITTED:

SIGNATURE:

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301

(850) 222-2400 FAX (850) 561-6758

DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2011

FPa Officer and Director nominationsAlthough we have just finished the election for a president-elect and directors for the odd num-bered regions to be installed at the 2011 annual meeting, it is time to start thinking about nominees for the 2012 election since the nomination deadline is September 1 of this year (9/1/11). As the form below indicates, this year we will need candidates for president-elect, treasurer, and directors for the even numbered regions. Please note that you may nominate yourself.

22 | f L O R i d A p H A R M A C y t O d A y

The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Monday, May 2, 2011. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to:

Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association

610 N. Adams Street Tallahassee, FL 32301

tmerren@pharmview.com PLEASE TYPE Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________

□ Entry Level Pharm.D. □ Post B.S. Pharm.D. Address: ________________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________

Poster Type: □Clinical Research

□Basic Science Research

□Translational Research (Basic Science and Clinical Research) Primary Author: __________________________________________________________________________________

(Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student □YES □NO

Awards: Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)

Free Registration: Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration.

(Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration: □YES □NO

College: _____________________________________________________________________________

The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions.

Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.

Please direct all questions and concerns to: Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com

CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS For Florida Pharmacy Students

FLORIDA PHARMACY ASSOCIATION 121st ANNUAL MEETING AND CONVENTION

June 22 - 26, 2011 The Fairmont Turnberry Isle Resort & Club ♦ Aventura, Florida

Poster Session: Friday, June 24, 2011, 11:00AM-1:00PM

ABSTRACT FORMAT

DEADLINE DATE: MONDAY, MAY 2, 2011

M A R C H 2 0 1 1 | 23

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buyeR’s GuideADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

P H A R M A C Y T O D A Yflorida

Advertising in Florida pharmacy todaydisplay Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. professional Referral Ads: FPA Members: $50 per 50 words; Non-members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.

AHCA MEDICAID PHARMACY SERVICES2727 Mahan DriveTallahassee, FL 32308(850) 487-4441www.fdhc.state.fl.us/medicaid/pharmacy

AMERICAN PHARMACISTSASSOCIATION (APhA)Washington, D.C. (800) 237-2742www.pharmacist.com

AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTSBethesda, MD (301) 657-3000www.ashp.com/main.htm

DRuG INFORMATION CENTERPalm Beach Atlantic University(561) 803-2728druginfocenter@pba.edu

FLORIDA BOARD OF PHARMACY4052 Bald Cypress WayBin #C04Tallahassee, FL 32399-3254(850) 245-4292www.doh.state.fl.us/mqa

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NATIONAL COMMuNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314703.683.8200703.683.3619 faxinfo@ncpanet.org

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