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IHE Pharmacy domain Medication Documentation A structured genealogy of the way into chaos …

IHE Pharmacy domain Medication Documentation A structured genealogy of the way into chaos …. Jürgen Brandstätter IHE Pharmacy co-chair. What do we need ?. Medication information to support clinical decisions (e.g. prescribing ) “ Get current medication “ of the patient

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IHE Pharmacy domain Medication Documentation A structured genealogy of the way into chaos …

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  1. IHE Pharmacy domainMedicationDocumentationA structuredgenealogyofthewayintochaos … Jürgen Brandstätter IHE Pharmacy co-chair

  2. What do weneed? • Medicationinformationtosupportclinicaldecisions (e.g. prescribing) • “Getcurrentmedication“ ofthepatient • Was a requiredtransactionbyinitial Pharmacy whitepaper • Aka MedicationRecord, CurrentMed List, Medication Profile, … • But whatisthat? • First approach: The activeingredientsthatarecurrently still active in thepatient‘sbody • Can wegetthat? • Yes andNo, at least hardlyto 100% • Betterchances in Hospital Pharmacy • Pitfalls in Community Pharmacy

  3. What do weneed? • Whatarethepitfalls in Community Pharmacy • Wedon‘tknowforsureifthepatientactuallytakesthemedication he shouldtake • Wedon‘tknowforsurewhatelsethepatienttakes • Wedon‘tknowforsurehowlongingredientsare „active“ Weknowandacceptit … anddon‘tcareaboutitfromnow on

  4. Hopefulin thebeginning • Pharmacy meetingatConnectathon in Pisa 2011 • The solutionseemsnear: Let‘stakethe „Austrian approach“ • Providethefollowingtotheprescriber: • All open prescriptions • All dispensesofthe last x months • Advantages • (Austrian) prescribersseem happy withthat • Information is easy toget • Yetquiteaccurat • Seemstobe a rathersufficientassistanceforPhysicians • Disadvantages • Somemedicationmightbeactivelongerandcouldbeoverseen (but work-aroundwouldbeathandbyenhancingthemedicationdatabase) • Expectedreactionofthegroup • Applause andkick-offto design IHE transactionstodeliverthisinformation • Actualreactionofthegroup • Nonono, thatisthoughtfarto simple  • Weneedmorethinkingaboutthistopic! Follows 80 / 20 rule

  5. Overwhelmedright after Looking around: Who deals with that? Austria IHE Pharmacy Netherlands HL7 Pharmacy Australia HL7 CCD IHE PCC UK US (NCPDP) ASTM CCR CEN 13606 … …

  6. Realisticafter recovering • Weneed … • tocollaboratewithotherstosortthat out • tothinkabout all thesourcesofmedicationinformation • Pharmacy, Oncology, Radiology, EHRs, Patient Summaries, … • tothinkabout all thecontextessuch informationis registered • Prescribing, Dispensing, MedicationReconciliation, DischargeSummaries, … • todefinethescopeIHE Pharmacy isable/allowedtocover In otherwords: Weneeded a Whitepaper

  7. Chaoticatthemoment • Many pieces are already on the table • The Whitepaper is drafted, but far from being final • Optimistic guess: Season 2012/2013 • The (huge) topic has been divided into two (still huge) tracks: • Bottom-up approach: „What do we have“ • Top-down approach: „What do we need“

  8. Chaoticatthemoment • Bottom-up approach: „What do we have“ • Objective of this approach • Identify Sources and Context • Identify the information sources and their respective context • Requirements for exchange • Expose the requirements for exchanging information between different systems in similar or different contexts • Common structure • Propose a reference structure that accommodates the representation of medication information of different sources

  9. Chaoticatthemoment • Top-down approach: „What do weneed“ • Working title: „Pharmacy EHR Functionalprofile“ • Collaborationworkwith HL7 Pharmacy • PhD Thesis is in themaking • Requirementsanalysisof … • … (1) thePharmacy partof an EHR • … (2) a Medicationprofile • Findings so far: • Pharmacy partof EHR: Phycisian‘sview • Medicationprofile: Pharmacist‘sview • Currentfocus on thequestion: Whereistheboundary? • Currentworkhypothesis: • Pharmacy partof EHR: foroptimal clinicaldecision • Medicationprofile: foroptimal Pharmaceuticaladvising

  10. Silverlinegets in sight • The „two track“ approach seem promising • Resulted in clear division of work • IHE: Lead in „bottom-up“ approach • HL7: Lead in „top-down“ approach • Will get a scientific foundation • By PhD thesis • Already developed concepts can likely be re-used • IHE, NCPDP, … • Many people enthusiastically engaged 

  11. Side effect: New profile? • MedicationTherapy Plan • „Howtorecord a change in medicationtherapywhenthereisnoprescription?“ • Anotherlevelas PRE/PADV/DIS workflow (CMPD) • Isimportantforbothtracks • Bottom-up: As additional source • Top-down: Mightbepartoftherequirements MedicationTherapy … Medication Order Medication Order … Prescription Pharm. Advice Dispense Prescription Prescription Pharm. Advice Dispense Workflow

  12. Link towhitepaper • Whitepaper 2010 – 2012 (and beyond) • Medication Documentation • “A proposal for consistent documentation and preparation of medication information from different sources to support clinical decisions” • ftp://ftp.ihe.net/Pharmacy/yr2_2010-2011/Technical%20Committee/WhitePapers/MedicationDocumentation/IHE_Pharmacy_WhitePaper_Medication_Documentation_v09.doc

  13. Discussion Please tell us … … what do you think?

  14. Links • Technical Frameworks • http://www.ihe.net/Technical_Framework/index.cfm#pharmacy • Pharmacy Wiki • http://wiki.ihe.net/index.php?title=Pharmacy • Strategic planning page • http://wiki.ihe.net/index.php?title=PHARM_Strategic_Planning • Roadmap • http://wiki.ihe.net/index.php?title=PHARM_Roadmap • Committees • http://wiki.ihe.net/index.php?title=Pharmacy_Planning_Committee • http://wiki.ihe.net/index.php?title=Pharmacy_Technical_Committee • Google group • http://groups.google.com/group/ihe-pharmacy

  15. Thank you Jürgen Brandstätter IHE Pharmacy co-chair, IHE International Board, IHE Austria Board CodeWerk Software Services and Development GmbH j.brandstaetter@codewerk.at

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