IHE Pharmacy domainIHE Pharmacy domain

Medication DocumentationMedication Documentation

A structured genealogy of the way into chaos …A structured genealogy of the way into chaos …

Jürgen BrandstätterJürgen Brandstätter

IHE Pharmacy co-chairIHE Pharmacy co-chair

What do we need?What do we need?

Medication information to support clinical decisions (e.g. prescribing) “Get current medication“ of the patient

• Was a required transaction by initial Pharmacy white paper Aka Medication Record, Current Med List, Medication

Profile, …But what is that? First approach: The active ingredients that are

currently still active in the patient‘s bodyCan we get that? Yes and No, at least hardly to 100% Better chances in Hospital Pharmacy Pitfalls in Community Pharmacy

What do we need?What do we need?

What are the pitfalls in Community Pharmacy We don‘t know for sure if the patient actually takes

the medication he should take We don‘t know for sure what else the patient takes We don‘t know for sure how long ingredients are

„active“

We know and accept it … and We know and accept it … and don‘t care about it from now ondon‘t care about it from now on

HopefulHopeful in the beginningin the beginning

Pharmacy meeting at Connectathon in Pisa 2011 The solution seems near: Let‘s take the „Austrian approach“

• Provide the following to the prescriber:– All open prescriptions– All dispenses of the last x months

• Advantages– (Austrian) prescribers seem happy with that– Information is easy to get– Yet quite accurat– Seems to be a rather sufficient assistance for Physicians

• Disadvantages– Some medication might be active longer and could be overseen (but

work-around would be at hand by enhancing the medication database) Expected reaction of the group

• Applause and kick-off to design IHE transactions to deliver this information

Actual reaction of the group• No no no, that is thought far to simple • We need more thinking about this topic!

Follows 80 / 20 ruleFollows 80 / 20 rule

OverwhelmedOverwhelmed right afterright after

Looking around: Who deals with that?

HL7 PharmacyHL7 PharmacyHL7 PharmacyHL7 PharmacyAustraliaAustraliaAustraliaAustralia

IHE PCCIHE PCCIHE PCCIHE PCC

ASTM CCRASTM CCRASTM CCRASTM CCR

HL7 CCDHL7 CCDHL7 CCDHL7 CCD

CEN 13606CEN 13606CEN 13606CEN 13606US (NCPDP)US (NCPDP)US (NCPDP)US (NCPDP)

AustriaAustriaAustriaAustria

NetherlandsNetherlandsNetherlandsNetherlands

UKUKUKUK

IHE PharmacyIHE PharmacyIHE PharmacyIHE Pharmacy

……………………

RealisticRealistic after recoveringafter recovering

We need … to collaborate with others to sort that out to think about all the sources of medication

information• Pharmacy, Oncology, Radiology, EHRs, Patient Summaries,

… to think about all the contextes such information is

registered• Prescribing, Dispensing, Medication Reconciliation,

Discharge Summaries, … to define the scope IHE Pharmacy is able/allowed to

cover

In other words: In other words: We needed a We needed a WhitepaperWhitepaper

Chaotic Chaotic at the momentat the moment

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“

Chaotic Chaotic at the momentat the moment

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

Chaotic Chaotic at the momentat the moment

Top-down approach: „What do we need“ Working title: „Pharmacy EHR Functional profile“

• Collaboration work with HL7 Pharmacy• PhD Thesis is in the making

Requirements analysis of …• … (1) the Pharmacy part of an EHR• … (2) a Medication profile

Findings so far:• Pharmacy part of EHR: Phycisian‘s view• Medication profile: Pharmacist‘s view• Current focus on the question: Where is the boundary?• Current work hypothesis:

– Pharmacy part of EHR: for optimal clinical decision– Medication profile: for optimal Pharmaceutical advising

SilverlineSilverline gets in sight gets 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

……

Side effect: New profile?Side effect: New profile?

Medication Therapy Plan „How to record a change in medication therapy when

there is no prescription?“ Another level as PRE/PADV/DIS workflow (CMPD) Is important for both tracks

• Bottom-up: As additional source• Top-down: Might be part of the requirements

PrescriptionPrescriptionPrescriptionPrescription Pharm. AdvicePharm. AdvicePharm. AdvicePharm. Advice DispenseDispenseDispenseDispense

PrescriptionPrescriptionPrescriptionPrescription Pharm. AdvicePharm. AdvicePharm. AdvicePharm. Advice DispenseDispenseDispenseDispense

……

WorkflowWorkflow

Medication TherapyMedication Therapy

Medication OrderMedication OrderMedication OrderMedication Order

Medication OrderMedication OrderMedication OrderMedication Order

PrescriptionPrescriptionPrescriptionPrescription

Link to whitepaperLink to whitepaper

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

DiscussionDiscussion

Please tell us …

… what do you think?

LinksLinksTechnical 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

Thank youThank you

Jürgen Brandstätter

IHE Pharmacy co-chair, IHE International Board, IHE Austria Board

CodeWerk Software Services and Development GmbH

j.brandstaetter@codewerk.at