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Epharmacy in the Netherlands

Epharmacy in the Netherlands. André Blom KNMP Michiel Sprenger VuMc, NICTIZ (per 1/3/08) , IHE. Agenda. Status (e)pharmacy Interoperability scenario’s in hospital and community pharmacy Dutch drug database G-standard. Current s tatus (e)pharmacy (1). The netherlands 16 mio people

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Epharmacy in the Netherlands

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  1. Epharmacy in the Netherlands André Blom KNMP Michiel Sprenger VuMc, NICTIZ (per 1/3/08) , IHE

  2. Agenda • Status (e)pharmacy • Interoperability scenario’s in hospital and community pharmacy • Dutch drug database G-standard

  3. Current status (e)pharmacy (1) The netherlands • 16 mio people • 100 hospitals (8 academic) • 1800 community pharmacies • 100 hospital including hospital pharmacies • > 10 transmural pharmacy service points • 3 main community pharmacy system suppliers (local) • > 5 hospital pharmacy system suppliers (usually integrated within within hospital information systems, local) • Long tradition in pharmacy IT > 25 years • Worldwide unique datamodel drugs (G-standard) • Basis for advanced electronic medication surveillance • Broad collaboration and exchange in primary care

  4. Currrent status (e)pharmacy (2) • > 20 regional networks for extended exchange edifact messages between regional healthcare providers (prescriptions/ referrals/ discharge summaries/ lab results) • 70% community pharmacies exchange medication data via local networks for medication surveillance during evening hours/duty (edifact) • 30% locum gp’s exchange professional summaries (edifact) • Electronic prescribing in primary care : 50-80% • directly from gp to pharmacy of choice via local networks • Electronic prescribing in secondary care • 30% clinical • 15% outpatient clinic • No significant electronic prescribing or exchange exit medication in transmural care • Edifact : de facto standard in primary care • Hl7 vs 2.x : de facto standard in secondary care

  5. National ehealth strategy (1) • National infrastructure (aorta) • AORTA basic infrastructure • National registration system for identification and authentication of patients, healthcare providers, insurers • National switch point (LSP) with a reference index for routing , identifcation, authentication, authorisation and logging • Care service providers for communication and services between local environments • Information systems of care organisations (GBZ) • Message standard (HL7 vs 3.0) Interoperability and standards HL7 vs 3.0 (reference model) basis for EHR SNOMED CT terminology

  6. National ehealth strategy (2) • Ehealth applications National EHR Virtual record comprising of a set of applications connected to national infrastructure • Electronical Medication Record (EMD)- history dispensed medicine - now in pilot • Patient summary (PS) locum GP – now in pilot • Followed by extended EMD • Includes allergies & contra-indications & lab & AE • Delivery and usage of medication • Future applications • E-diabetes • E-labs • E-emergency • E-pathology • E-radiology Eprescription Introduction of digital signature for physicians (through a new medicine act)

  7. Medication processes Hospital pharmacy • Inpatient (clinical) treatment • Outpatient treatment • Emergency treatment • Complete overview hospital medication processes are being currently defined including a national set of functional guidelines by Dutch Asscociation of Hospital Pharmacists (NVZA) and NICTIZ • Available Quarter I 2008

  8. Clinic Medication order Hospital pharm - Control & intervention 2. Prescribing 3. 1. Intake 4. Dispensing 5. Admin (intramuraal) no no Medication Cnange? 6. Evaluate Discharge ? yes Yes ER 20. Emergency room yes 7. Define exit medication consult Intake ? 21. Admin no Exit medication Prescription Outpatient clinic 10. Outpatient 12. Control & intervention 11. Prescribing 13. Dispense 14. Use consult (extramuraal) (Community/outpatient) pharmacy

  9. Exit medication Exit medication includes • Prescription that patient brings to pharmacy of choice • Information for gp and pharmacist regarding changes in medication related to intake of patient (home medication) in order to update their EMR Relevant integration aspects : • Integration with information system of hospital’s pharmacy • Integration with information system of community pharmacist’s • Integration with GP information system for receiving acknowledgements

  10. Other business processes pharmacy (in addition to dispensing) • Dispensing • Counselling • Pharmaceutical consultations • Medicine Use Reviews (MUR) • Pharmacotherapeutical Treatment Plans (FTP) • Medication surveillance • (repeat) prescriptions • Adherence and Concordance programmes • Pharmacotherapy audit meetings (PTAM) • Public Health Prevention programmes • Financial declaration of services at the national insurers /governments • Additional processes within the pharmacy are: • Reporting and evaluation of adverse effects • Reporting and evaluation of medication errors • Contribution to scientific research • Contribution to disease management programmes Relevant integration aspects To be defined

  11. E-lab • Information exchange important between (community) pharmacies and (clinical) labs • Lab information improves medication surveillance by pharmacists • Retrieve lab history • Order lab tests • Labs can better interpret data if they have medication use of patients • Retrieve medication use Relevant integration aspects Integration within (hospital) pharmacy information systems Integration within lab information systems National e-labs programme Collaboration between NICTIZ, IHE and healthcare providers

  12. G-Standaard / Dutch Drug Standard Structured drug database with information about: • the backbone, based on a fixed set of characteristics • prescribing, ordering, administering, reimbursement • medication surveillance: • contra-indications • Allergies • Pharmacogenetic data • drug-drug-interactions • dosage check • label texts, etc. • logistics (in cooperation with GS1) • Legislation

  13. Manufacturer Physician prescription visit Pharmacy goods medication invoice order Patient invoice Wholesaler Health insurer

  14. History • Developed by KNMP and privatized in 1999 (Z-index) • structure is based on roughly 25 years of practical experience • pharmaceutical content is maintained by a dedicated group of more than 20 full time pharmacists • installation of committees for reimbursement, pharmacotherapy, logistics and identification. • technology working group for modifications to the database • International orientation • E.g. member of SNOMED, GS1-HUG, CEN/ISO, HL7

  15. Standardized identification The medicinal products are identified by a set of identifying characteristics • ingredient • pharmaceutical dosage form • route of administration • strength • packing • quantity per packing • etc. The characteristics are based on national standards and on international standards where possible: • substance name: INN • pharmaceutical form and route of administration: Standard terms of European Pharmacopeia Commission • strength: SI-units

  16. Structure

  17. Structure • at this moment the structure is a national standard (NEN 7507: Basic structure of a drug database) • next step: international ISO standard

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