editor’s note
abbreviations
acknowledgements

The purpose of CMI

CMI is designed to provide accurate, up-to-date information to consumers about prescription medicines and pharmacy-only medicines. Individual CMI leaflets (CMIs) should provide all the information users might need about a specific medicine product. CMI is provided in the wider context of health information as a communication and counselling link between healthcare providers and medicine consumers. The content of CMI is taken from the Product Information (PI) of the medicine written by the medicine’s sponsor or manufacturer; nothing may appear in the CMI that is not in the PI, so consumers can be confident that they are being given reliable information. Also, nothing may appear in the CMI that can be seen as an advertisement or endorsement of the brand developed by pharmaceutical companies.
Ideally, whenever a prescription medicine is dispensed at a community pharmacy, the pharmacist should give the relevant CMI to the medicine user, pointing out important details of usage.

Mass customisation of documents

The system used to generate pharmacy CMI is an example of a system for mass customisation of documents. Such systems are widely used, and in many fields they are superceding the mass production technology which has been used to print documents for the last 500 years. In the older technology, a single document is reproduced many times over. In the newer technology a set of rules is used to drive the printer so that every single document is customised for the eventual user. A simple example of this mass customisation is the form letter which is individually addressed to a particular recipient, though the content remains the same for all recipients. A more sophisticated version is the bill, where not only the name and address of the recipient but the amounts and descriptions of the items are customised. Many examples exist of even more sophisticated customisation involving complex logical rules that make decisions about specific content on individual letters, depending on multiple characteristics of the recipient.

Figure 1: An example of personalised document production

Standard Letter life insurance
The illustration is of a single document produced on a platform with similar limitations to that used for CMI, at around the same period (1990-95). But in this case each document printed is customised for an individual customer.

The facility to move to this level of customisation was built into the original CMI specifications, but, like many other specifications, they were never implemented.

figure 2: information design process

The design of CMI for pharmacies

The design was developed using an established information design process as shown in Figure 2.

The appearance of CMI in general use today is highly constrained by the document customisation system used for printing in pharmacies at the point of dispensing in 1992. The system is built into the pharmacists’ dispensing software, which has very limited print control features. In some cases, pharmacists were still using dot matrix printers. At best, the software can output the crude word-processing code designed for laser printers in the mid-1980s, using the small number of resident fonts in pharmacists’ printers. The fonts used for CMI have to be chosen from those most commonly available on dot matrix printers or primitive laser printers

In the case of dot matrix design, the choice of font is restricted to two sizes of the same dot structure, available in regular, bold, and italics. Line spacing is single or double. There is no control over pagination or columns.

In the case of laser printing design, the fonts are restricted to Times and Helvetica, these being the most commonly available fonts on laser printers. These printers have slightly more flexibility in font sizes, line and paragraph spacing, but not much. Letter spacing is governed by simple proportional spacing rules. Altogether, the system has fairly crude specifications, not unlike Microsoft Word 3.0.

The full project to develop these designs, with all their limitations, is reported as one of our case histories.1Penman, Robyn, David Sless, and Rob Wiseman. “Best Practice in Accessible Documents in the Private Sector,” In Putting it Plainly: Current Developments and Needs in Plain English and Accessible Reading Materials, Canberra: Australian Language and Literacy Council, 1996.

Anticipating the possibility that CMI might one day be implemented by professional document production systems, CMIs designed by CRI were specified with advanced document-structuring features, using styles and sgml/xml-like definitions. These flexible styles and definitions—known collectively as responsive designs make it possible for CMI to be migrated from crude print to today’s more sophisticated modes of presentation: mobiles, pads, full colour printing etc.
Sadly, the FGA which is responsible for CMI appearance at the point of dispensing, has stripped out all the coding that would enable a smooth transition to new technologies. The consequences of this is that we now have thousands of CMI that cannot meet contemporary needs and technologies without major reworking. Who is going to bear these costs?

Standards for good document design

It is useful to evaluate CMI against established standards for good document design which have been developed and applied across a wide range of document types such as forms, legal documents, instruction guidelines, web sites and product labelling .2Sless, David. “Designing Public Documents.” Information Design Journal + Document Design Journal 12, no. 1 (2004): 24–35.. Below is a summary of the standards. You can also see the standards discussed in detail here.

It is a matter of common experience in our time that we are all routinely confronted by more information than we can absorb. As a consequence, people have developed information avoidance strategies, such as filling our recycling bins with all the documents we don’t want to look at. A document must rise above a certain threshold to avoid becoming landfill or recycling material.

Before people engage seriously with the content of any public document, they first have to read it – and they choose to read the documents that display the following desirable attributes.

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