ihe pharmacy domain profiles for community and hospital pharmacy jürgen brandstätter ihe pharmacy...
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IHE Pharmacy domainIHE Pharmacy domain
Profiles forProfiles forCommunity and Hospital Community and Hospital
PharmacyPharmacy
Jürgen BrandstätterJürgen Brandstätter
IHE Pharmacy co-chairIHE Pharmacy co-chair
PharmacyPharmacySince 2009Since 2009
PathologyPathologysince 2006since 2006
Radiation OncologyRadiation Oncologysince 2004since 2004
RadiologyRadiologysince 1998since 1998
CardiologyCardiologysince 2003since 2003
Patient Care DevicesPatient Care Devicessince 2005since 2005
Patient Care CoordinationPatient Care Coordinationsince 2005since 2005
Eye CareEye Caresince 2006since 2006
QualityQualityResearch & Public HealthResearch & Public Health
since 2007since 2007
LaboratoryLaboratorysince 2003since 2003
(Healthcare)(Healthcare)IT InfrastructureIT Infrastructure
since 2003since 2003
since 2008since 2008
Quelle: IHE InternationalQuelle: IHE International
Pharmacy within IHE landscapePharmacy within IHE landscape
IHE Pharmacy overviewIHE Pharmacy overview
• Pharmacy (PHARM)– Since 2009
– “IHE Pharmacy addresses information sharing, workflow and patient care in both community and hospital pharmacies.”
– 1 whitepaper, 5 profiles
– Sponsors & Supporters• EAHP• NICTIZ• Réseau Phast
Cover the overall process from Cover the overall process from prescription at the GP to dispense at prescription at the GP to dispense at
the Pharmacythe Pharmacy
Our needs Our needs in communityin community
Cover the overall medication workflow from Cover the overall medication workflow from prescription via validation and dispense to prescription via validation and dispense to
administration to the patientadministration to the patient
Our needs Our needs in hospitalin hospital
Committee work follows the IHE Profile Cycle Annual cycle
• Sep – Dec: Call for proposals• Dec – Jun: Working on work-items• Jun – Jul: Public comment• Jul – Aug: Ballot & Release
Opportunities for IHE members and non-members to participate in cycle (join http://groups.google.com/group/ihe-pharmacy !)
Participate IHE’s Profile CycleParticipate IHE’s Profile Cycle
How to participate in Pharmacy How to participate in Pharmacy ……
Our approachOur approach
Create a common data model for pharmacy domain
Profile existing standards: Hospital pharmacy: HL7v2.x standard (Message-based) Community pharmacy: HL7v3 CDA standard (Document-based)
Technical Framework describes the details of each Integration Profile (data model, messages)
Connectathons (first at Pisa, April 2011) to validate implementations of the IHE Pharmacy Integration Profiles
Welcome additional members (users, vendors)
IHE White PaperIHE White Paper
Final version Final version (integration of (integration of comments collected after having been put comments collected after having been put for public comments last year)for public comments last year)
70 pages70 pagesCommunity Pharmacy use casesCommunity Pharmacy use casesHospital Pharmacy use casesHospital Pharmacy use casesHarmonization of actors Harmonization of actors definitionsdefinitions
ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.2.pdf ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.2.pdf
What has been done?What has been done?
What has been done?What has been done?
5 profiles for … … Community Pharmacy
• CMPD Community Medication Prescription and Dispense• PRE Content Profile: Medication Prescription• PADV Content Profile: Pharmaceutical Advice• DIS Content Profile: Medication Dispense
… Hospital Pharmacy• HMW Hospital Medication Workflow
IHE Pharmacy – Key processIHE Pharmacy – Key process
Common Data ModelCommon Data Model
Data Model describe the data elements and their relations
Common for hospital pharmacy and community pharmacy
Derived from the model: HL7v2 messages and CDA documents
HL7v3 CDAPharmacy CMETs
Supply Chain
...
Prescription
PharmaceuticalAdvice
Dispensing
Administration
Prescription
PharmaceuticalAdvice
Dispensing
Administration
Supply Chain
...
2009-2010 cycle2009-2010 cycle
CMPDCMPD
PREPRE
PADVPADV
DISDIS
HMWHMW
Existing Profiles with High Uptake
CMPD (Community Medication Prescription and Dispense) Basic use case
• GP prescribes• Someone validates the prescription• Community pharmacist or pharmacy
dispenses Systems it would impact:
• Prescription placer module in GP systems• Pharmaceutical validation software• Pharmacy software
Based on IHE ITI XDS:• Strong integration with existing CDA/XDS-
based solutions
+ PRE Medication Prescription+ PRE Medication Prescription
+ PADV Pharmaceutical Advice+ PADV Pharmaceutical Advice
+ DIS Medication Dispense+ DIS Medication Dispense
Community Pharmacy profilesCommunity Pharmacy profiles
CMPD actor diagramCMPD actor diagram
CMPD Workflow scenarioCMPD Workflow scenarioPharmaceutical AdviserPharmaceutical AdviserPrescription PlacerPrescription Placer Medication DispenserMedication Dispenser
Ordering Dispensing
PHARM-1 , Query:FindPrescriptionsForDispense•Prescription document contains at least one Prescription Item ready to be dispensed.•A Prescription Item is ready to dispense if there exists a Pharmaceutical Advice Item related to it which has statusCode set to “completed” and code=OK or CHANGE.
Validation
PHARM-1, Query: FindPrescriptionsForValidation
Next task:„Validation“
Next task:„Ordering“
Condition: Always Condition: if PADV exists with statusCode=completed AND code=OK or CHANGE
Condition: if PADV exists with statusCode=completed AND code=REFUSE
StopCondition: if PADV exists with statusCode=completed AND code=CANCEL
Next task:„Dispensing“
•Prescription document contains at least one Prescription Item ready to be validated.•A Prescription Item is ready to validate if there exists no Pharmaceutical Advice Item related to it which has statusCode set to “completed”.
Content ProfilesContent Profiles
Content Profiles define „payload“ of CMPD system PRE PADV DIS
Based on HL7v3 CDA extended by HL7 Pharmacy CMETs
Existing Profiles with High Uptake
HMW Basic use case:
• Hospital physician prescribe in a ward• Hospital pharmacist review orders• Pharmacy technician dispense• Nurse administers drugs to the patient
Systems it would impact:• Prescription placer• Pharmaceutical advisor• Medication dispenser• Medication administration informer
Based on HL7 v2.x:• Message based to fit into hospital
environment
04/19/2304/19/23 1717
Hospital Pharmacy profilesHospital Pharmacy profiles
HMW actor diagramHMW actor diagram
Prescription Placer
Pharmaceutical Adviser
MedicationDispenser
Medication Administrator
Informer
↓ Medication Order [PHARM-H1]
Pharmacy Validated Order [PHARM-H2] ↓
Dispense Report[PHARM-H3] ↓
↑ Administration Report [PHARM-H4]
↓ Advance Prescription Notification [PHARM-H5]
Validated Order Confirmation [PHARM-H6] ↓
HMW Interoperability ModelHMW Interoperability Model
Becoming real …Becoming real …
• European Union: epSOS• Definition of prescription and dispense document aligned
• Austria / Europe: e-Medication project– Adoption of PRE und DIS specifications in pilot– Full adoption for rollout
• Italy / Europe: DOGE project
– Venice region (5 million inhabitants)
RoadmapRoadmap
• Current work-items– Medication record
– Aka „Medication documentation“ / „Medication treatment plan“– Cross-domain work with other IHE domains and HL7
– Exceptional cases• Extension of use-cases in CMPD and HMW
– Whitepaper: Supply chain in Hospital Pharmacy– Whitepaper: Transition „Community – Hospital“– Automatic administration by Infusion pumps
– Cross-domain work with IHE Patient Care Devices domain– Common Glossary
– Cross-domain work IHE and HL7
– Upcoming work-items– HL7v3 messages– Prescription of non-medication products
LinksLinks
• 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
Thank youThank you
Jürgen Brandstätter
IHE Pharmacy co-chair
CodeWerk Software Services and Development GmbH