ihe pharmacy: from profiles to concrete implementation · 2017. 6. 30. · a dv i ser m edi cati on...

IHE Pharmacy: From profiles to concrete implementation

Stéphane Spahni, PhD

IHE Finland

June 13, 2017

service de cybersanté & télémédecineconnec&ter les HUG avec le monde 2

Agenda

IHE Pharmacy

IHE Pharmacy Profiles

Implementations: MonDossierMedical.ch (Geneva, Switzerland)

ELGA (Austria)


IHE Pharmacy

Constituted in 2008

Currently 11 members 3 hospital pharmacists

2 users (hospitals)

6 vendors & other associations

Current work items: medication administration, supply chain, medication management, formularies

Sponsors / supporters: EAHP (European Association of Hospital Pharmacists), NICTIZ (Dutch National IT Institute for Healthcare), Réseau PHAST (French Network for Pharmacy Standards)

Liaison / collaboration with ISO and HL7


IHE Pharmacy Profiles

First profiles published in 2010 PRE * : Prescription content profile

DIS * : Dispense content profile

PADV: Pharmaceutical Advice content profile

CMPD: Community Medication Prescription and Dispense (Document-based)

HMW: Hospital Medication Workflow (Message-based)

2014: PML - Pharmacy Medication List content profile

2015: MTP - Medication Treatment Plan content profile

2017: ADM - Administration content profile?

* Included in the list of 27 profiles eligible for referencing in public procurement


IHE Pharmacy White Papers & Articles

IHE Pharmacy White Paper (2010) Foundation of all current profiles

Community Pharmacy use cases

Hospital Pharmacy use cases

Harmonization of actors definitions

Healthcare products supply chain White Paper (2017?) Describes the supply and procurement of products used for diagnostic,

therapeutic, or other healthcare purposes

Educational article for the Falsified Medicines Directive Describes how interoperability can support the effort against falsified

medicines, as laid out in the Falsified Medicines Directive - EU Regulation 2016/161


Community Pharmacy Workflow

Prescription

Specialist, GP

Pharmaceutical

Advice

Pharmacist, GP,

System, …

Dispense

Pharmacist

Administration

Patient, Nurse, Family member

Rejected Repeat

dispense

Dispensed

Approved Prescribed

Clinical result of medication

Plan

Specialist, GP

Planned

MTP DISPREPADV

ADM


Hospital Workflow (HMW profile)

Prescription Placer

Pharmaceutical

Adviser

Medication

Dispenser

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] ↓


Becoming real: two realizations

Geneva’s Shared Medication Treatment Plan Increasing patient safety by sharing the “Medication Treatment Plan” of

a patient between all stakeholders (hospitals, private physicians, pharmacists, home care, …)

Cantonal roll-out – part of the regional Health Information Exchange

Austrian’s e-medication platform Increasing patient safety by providing a “Medication List” of a patient

for physicians and pharmacists to support prescribing and medication interaction checking

Nation-wide rollout (8M people): All physicians and pharmacists will be connected (started Dec 2015, mandatory use for physicians and pharmacies starting 2017)


MonDossierMedical.chShared Medication Treatment Plan

(Geneva, Switzerland)


Shared Treatment Plan in MonDossierMedical.ch

MonDossierMedical.ch Regional Health Information Exchange (HIE)

Record owned by the patient

Shared Medication Treatment Plan All the medication taken by the patient

Consolidated view

Contributors: physicians, GPs, pharmacists, home nurses, …

Possibility to get a printable prescription or the patient’s treatment card


Treatment Card


eMedication landscape


Process followed

Analysis of IHE Pharmacy profiles proposition of new profile (MTP)

National profile: MTPS (Medication Treatment Plan Sharing)

Workgroups within MonDossierMedical.ch community (users, technical) feed-back to IHE Pharmacy asking for extensions

Implementation of a library easing coding / parsing of CDA documents (eHealthConnector, open source)

Implementation in MonDossierMedical.ch business logic

Implementation in stakeholders softwares


ELGA e-Medication(Austria)

ELGA – The Electronic Health Record in Austria

17ELGA & e-Medication (courtesy of DI Dr. Alexander Kollmann, ELGA)6/27/2016

national IT infrastructure(e.g. master patient index, HCP index, access management system, portal, logging system, security)

national IT infrastructure(e.g. master patient index, HCP index, access management system, portal, logging system, security)

EL

GA

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ms in

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nd

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e.g

. dis

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mary

)

EL

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EL

GA

-Ap

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n

(e.g

. e

-medic

ation

)

EL

GA

-Ap

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ca

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n

(e.g

. e

-medic

ation

)

citizen & (public) hospitals(selected general practitioners & pharmacies)

citizen & (public) hospitals(selected general practitioners & pharmacies)

further ELGA-Applications

(e.g. e-vaccination record)

more structured data &

documents (CDA)

Go-Live until 06/2016

3 ELGA areas

e-Medication (started 05/2016 in a

selected starting region)

more user and usergroups

1

2 3

4

Conditions of the project „e-medication“


drug

approvalprescription dispense administration

patient/ treatment safety

drug safety

pharmacovigilance

patient empowerment

GREEN: scope of the project (ML … medication list)

national approval

number

e-prescription

IC ICML MTP

GREY: out of scope: (IC … interaction check; MTP … medical treatment plan)

collaboration & information

e-Medication: Community Medication

Prescription and Dispense

19

general

practitionerpharmacy

prescription(paper)

e-Medication

database

prescription(electronically)

store prescriptionsretrieve prescriptions

store dispenses

business logic

e-Medication listAggregated list of prescriptions and

dispenses (and pharmaceutical

advices)

Merging prescriptions, dispenses and

pharmaceutical advices

list of dispenses

list of

prescriptions

„ra

wd

ata

“ o

nly

for

HC

P a

cce

ssib

le

eMED-ID as

Identificator

Visualization via ELGA portal and

download for HCP possible

dispense(electronically)

2

1

3

4

5

6/27/2016 ELGA & e-Medication (courtesy of DI Dr. Alexander Kollmann, ELGA)

e-Medication: Hospital Medication Workflow

20ELGA & e-Medication (courtesy of DI Dr. Alexander Kollmann, ELGA)

hospital

discharge letter

(recommended

medication)

prescription

pharmacy

store dispenses

GPtranscribes

recommended

medication

medication list

admission discharge

IT-

SystemIT-

Systemprescription

ELGA

e-reports

6/27/2016

out of scope: internal

medication process

Medication List


Technical aspects

On-Demand-Document according to international standards

IHE Pharmacy [Link] & CDA [Link]

ONE DATAMODEL – different views!

Content

Highly structured data (CDA-Level 3)

Contains and maps different identifiers (e.g. ATC for ingredients, national

approval number)

Contains up-to-date and detailed information about people and

organisations who took part in the medication process

http://www.ihe.net/Pharmacy/https://www.elga.gv.at/technischer-hintergrund/technische-elga-leitfaeden/index.html

View 1: Patient / ELGA-Portal (1/2)Overview

6/27/2016 ELGA & e-Medication (courtesy of DI Dr. Alexander Kollmann, ELGA) 22

View 1: Patient / ELGA-Portal (2/2)Details


View 2: Hospitalhttps://www.elga.gv.at/fileadmin/user_upload/Dokumente_PDF_MP4/CDA/ELGA-emed_Stylesheet_v1.0.xsl


Medication list (overview) Import selected data into the

hospital information system

https://www.elga.gv.at/fileadmin/user_upload/Dokumente_PDF_MP4/CDA/ELGA-emed_Stylesheet_v1.0.xsl

View 3: general practitioner/ pharmacyschematic – implementation depends on the software

256/27/2016

dispense part

prescription part

Source: Project „e-Medication“, SVC GmbH

ELGA & e-Medication (courtesy of DI Dr. Alexander Kollmann, ELGA)

Thank you for your attention!

[email protected]

ihe pharmacy: from profiles to concrete implementation · 2017. 6. 30. · a dv i ser m edi cati on...

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