This article describes how an industry-leading online pharmacy safely and successfully fills thousands of prescriptions each day using an ordering and workflow system built on top of SUSE Linux and Emic's clustering application solution.

Prescription drugs are consuming more and more dollars of each American's health care budget.The increase in prescription drug cost has helped drive the double-digit health insurance rate increases we have experienced in each of the past three years. To be able to lower overall costs and thereby continue to offer competitive health insurance benefits to employees and retirees, many public entities, such as the states of Illinois, Vermont, and Wisconsin, are driving programs to import prescription drugs from Canada and other countries.

Opening a new front in the fight over the cost of prescription drugs, Gov. Rod R. Blagojevich of Illinois is preparing to help residents of his state buy cheaper medicines from Canada, Britain, and Ireland. Vermont will become the first state to sue the federal Food and Drug Administration (FDA) for rejecting a plan to import prescription drugs from Canada. Reacting to intense pressure to help make prescription drugs more affordable, Vermont officials had asked the drug agency to approve its plan.

A bipartisan group of senators announced that they had reached an agreement on a bill to allow imports of lower-cost prescription drugs from Canada and a few other countries. The agreement adds momentum to the push for legislation to legalize imports of prescription drugs, with some major drugstore chains, a number of state attorneys general, and several insurance companies endorsing the plans.

This is just a summary of several recent headlines on the topic of importing drugs from Canada. While the intent of this article is not to analyze the politics around purchasing prescriptions from Canada - to anyone in the U.S. it makes sound economic sense - we must recognize that to date over a million U.S. consumers are quietly and safely filling their prescriptions using online pharmacies in Canada, saving an average of 50% over what they would pay in the U.S. While the FDA continues to fight large-scale efforts to import medicines, the agency is allowing individuals to import medicine as long as it is for their personal use.

One of the main requirements for online medication purchase is safety. Any online pharmacy that will be successful in meeting this requirement must pass many hurdles. Some of these steps involve accreditation by independent bodies, others the creation of reliable internal processes that ensure the safety and accuracy of each prescription order, and others the development of the application systems that operate the online pharmacy, reliably implementing these processes at each step and for each prescription.

CanadaDrugs.com is one of the leading mail-order pharmacies in patient safety. Under strict quality assurance measures, every step is taken to ensure the safety and accuracy of each prescription order. CanadaDrugs.com is helping to shape the industry's future through our commitment to patient safety by meeting or exceeding all standards set by organizations such as MIPA (Manitoba International Pharmacists Association), CIPA (Canadian International Pharmacy Association), and being the first pharmacy accredited by U.S.-based IMPAC (Internet and Mailorder Pharmacy Accreditation Commission). CanadaDrugs.com is committed to meeting or exceeding all United States HIPAA regulations.

CanadaDrugs.com has responded to the need to maintain consumers' trust by building an order-fulfillment process that is both safe and robust. Further, a system infrastructure was needed that could deliver enterprise-class, highest service-level software, yet do so in a cost-effective way using open source and low TCO components. To accomplish this, we built a cost-effective, scalable, high-availability system using Emic's Application Cluster (EAC) on top of open source components, allowing us to pass the added savings (as opposed to building applications on high-cost, proprietary hardware and software) to our customers without any compromise of quality at any stage.

To fill our growing online prescription orders accurately and quickly, our application systems, developed in conjunction with our systems integration partner, Metrex, run on SUSE Linux Enterprise version 8.0 with EAC. All nodes are IBM BladeServer (Intel Xeon) platform, each connected to its own SAN over FibreChannel.

This system runs on 24x7 reliability, meeting the trust our customers place in our organization, and accommodates thousands of transactions per second. It meets our requirement that we always have a consistent view of our data so that each pharmacist sees the same information regardless of whether any server is down or on which server the query or workflow step is processed. EAC keeps our system's availability high, provides failover protection, and balances the database load among our network of computer servers.

CanadaDrugs.com operates its entire workflow application on open source, commencing from an initial pharmacist review of every new prescription involving a minimum of three pharmacists throughout the dispensing process, therapeutically screening and assessing prescription orders for appropriateness, accuracy, potential allergic reactions and interactions, duplication of therapy, and even direct contact with the patient's U.S. prescribing physician regarding all drug-related problems. Upon completion of the final check by a pharmacist, the prescription order is released to be billed and then shipped using Canada Post and the U.S. Postal Service, with all orders insured and traceable. CanadaDrugs.com keeps the system up and running with Emic's Application Cluster.

We've been very happy with our working relationship with Emic Networks. Their EAC provides an innovative, advanced, and cost-effective software clustering solution for cornerstone open source business applications. EAC offers us high-availability, performance scalability, load-balancing, and single-point manageability services for our open source three-tier applications (database, application server, Web server).