View
218
Download
0
Category
Tags:
Preview:
Citation preview
Jürgen Brandstätter, MScCo-chair Pharmacy Planning committee
Co-chair Global Deployment Coordination Committee (GDC)
IHE International Board
CodeWerk Software GmbH, Austria
• IHE Pharmacy Domain Update
Webinar
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
What is IHE?
eHealth Projects
IHTSDO
IETF
Standards
?Use cases typically require„combinations“ of standards
- but how to compose?
What is IHE?
eHealth Projects
IHTSDO
IETF
Standards Profiling and Testing
Products
Projects
IHE methodology
Use Case
Identify available standards
Profile Development
Testing at Connectathons
Products declare
IHE
Easy to integrate products
RFPs with IHE
reqs
IHE: Difference to classic SDO
• Classic Standards Developing OrganizationDevelops „future“ standards in certain areas
• IHEUses „existing“ standards to profile Interoperability use-cases
IHE is a non-profit association dedicated to interoperability in health information technology.
IHE: A forum for agreeing on how to implement standards and processes for making it happen
Pharmacy within IHE landscape
Pathologysince 2006
Radiation Oncologysince 2004
Radiologysince 1998
Cardiologysince 2003
Patient Care Devicessince 2005
Patient Care Coordinationsince 2005
Eye Caresince 2006
QualityResearch & Public Health
since 2007
Laboratorysince 2003
(Healthcare)IT Infrastructure
since 2003
since 2008
Pharmacysince 2008
IHE Dental
IHE Endoscopy
Our needs in hospital
Cover the overall medication workflow from prescription via validation and dispense to the
administration to the patient
Our needs in community
Cover the overall process from planning medication and
prescription at the GP via dispense at the Pharmacy to ambulant
administration
IHE Pharmacy overview
Vision: “Pharmacy processes runs seamless in the community and hospital domain as well as cross-domain.”
Mission: “IHE Pharmacy produces profiles and guidance that addresses information sharing, workflow and patient care in both community and hospital domain.”
Most actively involved …• Many European countries• USA/Canada• Australia
1 whitepaper, 6 profiles, Whitepaper work on certain (rather complex) topics
Sponsors & Supporters• EAHP, NICTIZ, Réseau Phast
Strategic goals
• Promote widespread adoption and implementation of IHE Pharmacy developed profiles by ...
• Marketing and promoting the profiles globally• Reaching out for national/regional e-Prescription programs in order to
• (1) learn requirements and demands which lead to developments within IHE Pharmacy and
• (2) stimulate leveraging of IHE Pharmacy profiles as basis for their national specifications
• Improve information exchange between healthcare providers and organizations that depend on Pharmacy related workflows and processes
• Develop ways to automate collaborative workflow between physicians and pharmacists in both community and hospital pharmacy environment
• Establishing and maintaining collaboration to ...• other IHE domains• HL7 Pharmacy• ISO TC215 WG6 Pharmacy• NCPDP
Big success: European Commission recognizes 27 IHE profiles that “should be referenced in
public procurement documents”1)
-> 2 Pharmacy profiles included (PRE, DIS)!
1) http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
Liaisons
ISO TC 215 WG6 „Pharmacy“ / CEN TC 251Global recognition
HL7 PharmacyBase Standards
IHE PharmacyProfiling Layer
Friendly collaboration
Liaisons
ISO TC 215 WG6 / CENGlobal recognition
HL7 Pharmacy Base Standards
IHE PharmacyProfiling Layer
Contributions
User/Vendor Input
ISO Standards
Base and legal binding standards
Liaisons
ISO TC215 WG6 / CENGlobal recognition
HL7 PharmacyBase Standards
IHE PharmacyProfiling LayerProjects
High-level
TechnicalProfiles
(Use Cases) HL7 Standards
ISO Standards
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
Our approach
• Create and maintain a common data model• A common approach for Community and Hospital Pharmacy environment
• 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• Use-case• Actors, Transactions
• Connectathons to validate implementations of the IHE Pharmacy Integration Profiles
• First tested at European CAT in Pisa/Italy, April 2011
What has been done?
• 7 profiles for …
… Hospital Pharmacy• HMW Hospital Medication Workflow
… Community Pharmacy• CMPD Community Medication Prescription and Dispense• PRE Content Profile: Medication Prescription• PADV Content Profile: Pharmaceutical Advice• DIS Content Profile: Medication Dispense• PML Content Profile: Pharmacy Medication List• MTP Content Profile: Medication Treatment Plan1)
1) Currently in publishing process
The White Paper…
• IHE White Paper
Foundation of all current profiles
• Final version
Released in early 2010
• 78 pages
Community Pharmacy use cases Hospital Pharmacy use cases Harmonization of actors definitions
Current version: ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.3.3.pdf
IHE Pharmacy – Key process
Prescription
Specialist, GP
Pharmaceutical advice
Pharmacist
Dispense
Pharmacist
Administration
Patient, Nurse, Family member
Rejected Repeat dispense
Dispensed
Approved Prescribed
Clinical result of medication
Validation of the prescription(ICA check, etc.)
Hospital Pharmacy profile
Workflow and Content
Hospital Medication Workflow (HMW)– Basic use case:
• Hospital physician prescribes in a ward• Hospital pharmacist reviews orders• Pharmacy technician dispenses• Nurse administers drugs to the patient
– Systems it would impact:• Prescription placer modules• Pharmacy (Validation, encoding…) software• Medication dispensing systems• Medication administration informer modules
– Based on HL7 v2.5/v2.6:• Message based to fit into hospital environment
HMW Interoperability Model
HMW Interoperability Model
Medication Dispenser
(supply and distribution are covered, but not profiled yet)
Community Pharmacy profiles
Workflow
Community Medication Prescription and Dispense (CMPD)
•Technical Integration, Actors, Transactions, based on IHE ITI XDS
Content (based on HL7v3 CDA extended with HL7 Medication CMETs)
Prescription (PRE)• In sync with upcoming ISO DTS 17523
“Requirements for electronic prescriptions”and ePrescription guideline of the EU / eHGI
Dispense (DIS)• In sync with upcoming ISO DTS 19293
“Requirements for the record of DispenseMedicinal Products”
Community Pharmacy profiles
Content (based on HL7v3 CDA extended with HL7 Medication CMETs)
Pharmaceutical Advice (PADV)• Used for …
– Validating a prescription» e.g., Medication Interaction Checking Issue
Management– Managing of prescriptions and dispenses (Change,
Cancel, …)» Always related to PRE, DIS or MTP
Pharmacy Medication List (PML)• Information on prescribed and dispensed medication to a
patient• Contains Prescription-, Dispense-, Pharmaceutical Advice Items• „On-demand“ document
Medication Treatment Plan (MTP)• Information on planned medication to a patient• Contains Medication Treatment Plan Items (alike PRE items)• Prescriptions and Dispenses may be referencing MTP
CMPD actor diagram
Create Prescriptions/Dispenses
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]S
eHe
Rep
osi
tory
[SeH
e Sy
stem
]
SeH
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare Provider prescribes
in local HISStart
Store prescription
End
PrescriptionPrescription
Prescription document is
created by local HIS
Prescription document is printed and handed out to
patient
Dis
pen
ser
[PH
C, H
ospi
taL
Pha
rmac
y, e
tc.]
Dis
pen
ser
[PH
C, H
ospi
taL
Pha
rmac
y, e
tc.]
Seh
e R
epo
sito
ry[S
eHe
Syst
em]
Seh
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare Provider records the DIspensation
Record in local HISStart
Store Dispensation
End
Dispensation Dispensation
Dispensation is created by local
HIS
Medication is dispensed to the patient
CreatePrescription
Create Dispense
Create Prescriptions/Dispenses
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]S
eHe
Rep
osi
tory
[SeH
e Sy
stem
]
SeH
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare Provider prescribes
in local HISStart
Store prescription
End
PrescriptionPrescription
Prescription document is
created by local HIS
Prescription document is printed and handed out to
patient
Dis
pen
ser
[PH
C, H
ospi
taL
Pha
rmac
y, e
tc.]
Dis
pen
ser
[PH
C, H
ospi
taL
Pha
rmac
y, e
tc.]
Seh
e R
epo
sito
ry[S
eHe
Syst
em]
Seh
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare Provider records the DIspensation
Record in local HISStart
Store Dispensation
End
Dispensation Dispensation
Dispensation is created by local
HIS
Medication is dispensed to the patient
CreatePrescription
Create Dispense
Medication Interaction Checking
Manage Prescriptions/DispensesP
resc
rib
er[P
HC
, Hos
pita
l, et
c.]
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]S
eHe
Rep
osi
tory
[SeH
e Sy
stem
]
SeH
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare provider manages the
Prescription Item in the local HIS
Start
Store the update to the prescription
End
UpdateUpdate
Update document is created by local HIS
Manage Prescriptions/Dispensations
Manage Prescriptions/DispensesP
resc
rib
er[P
HC
, Hos
pita
l, et
c.]
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]S
eHe
Rep
osi
tory
[SeH
e Sy
stem
]
SeH
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare provider manages the
Prescription Item in the local HIS
Start
Store the update to the prescription
End
UpdateUpdate
Update document is created by local HIS
Manage Prescriptions/Dispensations
Medication Interaction Checking
Query/Retrieve Medication Documents
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]
Pre
scri
ber
[PH
C, H
ospi
tal,
etc.
]S
eHe
Rep
osi
tory
[SeH
e Sy
stem
]
SeH
e R
epo
sito
ry[S
eHe
Syst
em]
Healthcare provider sets query parameters and initiates the query for
prescriptions in the SeHe Repository
Start
Query prescriptions
End
PrescriptionPrescription
Processing of the prescription and related
documents by local IT system
Healthcare provider identifies the prescription
in the search result
Retrieve prescriptionand all related documents
Related documents
(e.g., Dispensation
Records)
Related documents
(e.g., Dispensation
Records)
The way of a prescription
PRE
Physician prescribes a
prescription with 5 prescription items
PI 1
PI 2
PI 3
PI 4
PI 5
PADV
The way of a prescription
PRE
Physician changes PI 1
PI 1
PI 2
PI 3
PI 4
PI 5
PADV 1PADV
PADV 3
Physician cancels PI 3
PADV
The way of a prescription
PRE
PI 1
PI 2
PI 3
PI 4
PI 5
PADV 1
Pharmacist dispenses all PIs
DIS
DIS 1 DIS
DIS 2
DIS
DIS 4 DIS
DIS 5
PADV
The way of a prescription
PRE
PI 1
PI 2
PI 3
PI 4
PI 5
PADV 1
Physician changes dosage of DIS 2
and instructs the patient to stop intake of DIS 5
DIS
DIS 1 DIS
DIS 2
DIS
DIS 4 DIS
DIS 5
PADV
PADV 2
PADV
PADV 5
Planning / Actual
PRE DIS DISPADV
Change
Plan
Actual
Action
Physician starts
medication treatment
Physician changes dosage
Patient runs out of medication
s
Physician changes dosage again
Logical flow Leads to
PRE DIS
MTPPADV
ChangePADVChange
Reference to MTP Reference to PRE Reference to DIS
Time
…
Becoming real – in epSOS
European Patient Smart Open ServicesGoals (relevant for IHE Pharmacy)
• Cross-border prescription and dispense• Demonstrated in pilot use
Covered use-casesPrescription query (cross-border)Dispense create (cross-border)
Community Pharmacy profiles usedContent: PRE, DIS
Synced1) Concept derived from epSOS2) Worked in sync with epSOS3) Further elaborated in IHE
Becoming real – in Austria
Austrian e-Medication projectGoal of the project
• 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 (8 mio people): All physicians and pharmacists will be connected•Rollout and startup on volunteer basis 2016, mandatory use for physicians and pharmacies starting 2017
To achieve the goal …•… prescriptions and dispenses have to be captured electronically to act as data-source for the medication list (e-prescription/dispense system)
•does not replace paper prescription yet (just for capturing data)!
Covered use-casesPrescription create / query / cancel / changeDispense create / query / stop intake / change dosage (including OTC)Query Medication List
Community Pharmacy profiles usedWorkflow: CMPDContent: PRE, DIS, PADV, PML
Embedded into national Health Record infrastructure (ELGA)based on IHE XDS
Becoming real – in Saudi Arabia
Saudi e-Health Exchange projectGoals of “Medication track”
• Introducing e-Prescription/Dispense (replacing paper)• Providing a “Medication List” of a patient for physicians and pharmacists• including hospital medications (out of discharge summary)• Provide a central service for “Medication Interaction Checking”• Specification phase now completed
Covered use-casesPrescription create / query / cancel / change / suspendDispense create / query / stop intake / change dosage / suspend (including OTC)Query Medication ListCentral Medication Interaction Checking and Issue Management
Community Pharmacy profiles usedWorkflow: CMPDContent: PRE, DIS, PADV, PML
Embedded into Saudi e-Health Exchange infrastructure (SeHE)
based on IHE XDS
Becoming real – in Switzerland
Swiss e-Medication projectGoal of the project (Geneva driven)
• Increasing patient safety by sharing the “Medication Treatment Plan” of a patient between all stakeholders (hospitals, private physicians, pharmacists, home care, …)
• Defining a national profile for sharing patient’s medication related information in relation with the forthcoming federal law on the electronic patient record (2017)
• Cantonal roll-out – hospital, physicians, pharmacists and home care will be connected to the shared treatment plan module of the regional Health Information Exchange
• Rollout and startup first quarter 2016 on a voluntary basisTo achieve the goal …
• Implementation of IHE content profiles based communication in the regional HIE• Implementation of the management of the CDAs as an OpenSource project (eHealth-Connector) in order to
ease the integration by third party vendors• Wide concertation will all stakeholders in the country in order to promote the national exchange format
Covered use-casesQuery Medication List and Medication list updatePrescription create / query / cancel / changeDispense create / query / stop intake / change dosage (including OTC)Add comments to plan / prescription / dispense (home care)
Community Pharmacy profiles usedContent: MTP, PRE, DIS, PADV, PML
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
Other Pharmacy activities
• IHE started by covering the clinical part of the medication circuit:
From prescription to administration
• Based on the de facto standards: CDA and HL7 v2.
• This clinical part must be interoperable with other parts:
• The distribution / supply of medication across and inside institutions
• The management of medications• Other processes using medication (radiology, surgery)
Supply of Products for Healthcare
• A cross-domain and cross-standard guidance on how to exchange information for the supply of products:
• Order from suppliers, delivery inside an institution, automated dispensing, traceability, barcode-enabled tracking and stock management
• Whitepaper being developed, work on profiles starting as well
• GS1 and HL7 are the enabling standards
Supply – areas covered
Catalog maintenance
Orders and returns
Inventory management
Usage report & tracking
Billing
Selection of vendors | Pricing & Contracts | Update product dataInternal data (Clinical data, internal prices, usage rules, usage
instructions)
Availability and recall
Permissions, availability, recall
Stock orders and bulk orders
Consignment items
Point of care ordering & order processing
Consult product data
Consignment items
Patient charges / intra-hospital charges
Hospital billing
Manufacturer Distributor Hospital
DispensingSystems Point of care
Patient usage
Stock status, consumption
Common Pharmacy Profile• Health IT is moving to support innovation, distributed
applications, mobile computing, web-enabled solutions, ...• This requires faster-to-adopt, faster-working interoperability.• HL7 FHIR is a draft standard that enables it.
• A new set of profiles is being created to advise implementers how to prepare for the new standard:• “The Common Pharmacy Profile”• Includes aspects like workflow management, constraints and
recommendations to support from traditional systems to mobile applications
• We do this by using the best of our existing profiles, our experience and preparing a common profile, ready for the future challenges
“Common” Panorama
Dispensing Administration
Supply
Medication Lists
ADE reporting
Planning
Medication Statements
Medication Catalog
PrescribingReview / Advice
For Communities For HospitalsFHIR-based (common)
ADE = Adverse Drug Event
Other activities
• Medication Catalog / Formulary• How do we identify medication across different systems? Are
names sufficient? Are codes necessary? How do we distribute the medication attributes across several systems?
• Medication Data capture / Medication Documentation• How to retrieve data from prescriptions, dispenses, etc. In
order to create a “medication list”
• Medication Administration (in Community domain)• More and more eligible to document electronically also in
Community domain• Ambulant Chemotherapy, Controlled drug-substitution, ...
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
So, do we need to change our habits?
eHealth is going to play a very important role in our real life in Hospital and Community Pharmacies
Emergence of patient-enabling solutions Increased trend to automate distribution of
medications Traceability becomes important – for clinical
reasons, as well as prevention of falsification
We (pharmacists) have to focus on the:
Clinical Pharmacy Use of medication across settings and domains Oncology Pharmacy Social Pharmacy Pharmacy Informatics …
Patients must be our main concern!
For Pharmacists, IHE Pharmacy, means:
Improved Hospital Pharmacy information through integrated access to medication information
Reduced physicians and nurses callbacks to pharmacists due to lack of medication information
Eliminating pharmacist call backs to physicians and nurses to resolve medications issues
Reduced pharmacists time to process special authority requests and logistics
IHE Pharmacy is the key to help us find solutions!
Learning objectives
• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and
ISO• Overview of existing PHARM profiles and Community and Hospital
Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan
• Overview of other PHARM domain activities, including Supply Chain, FHIR
• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work
How to participate in IHE Pharmacy
• 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• Register at http://groups.google.com/group/ihe-pharmacy
Meetings are F2F and TConsJust join in!
Participate IHE’s Profile Cycle
Links
• White Paperftp://ftp.ihe.net/Pharmacy/White%20Paper/
• Technical Frameworkshttp://www.ihe.net/Technical_Framework/index.cfm#pharmacy
• Pharmacy Wikihttp://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
• Changing the Way Healthcare CONNECTS
http://www.ihe.net
Our new mortar is digital
Recommended