Medication Documentation

Challenges and first impressions

José Costa Teixeira October 2014

Goal

• Exchange proper Medication Data, (instead of Medication Lists).

Exchange – Focus on interoperabilityProper – exchange data that is clearMedication Data – regardless of the purpose or additional data needed, help the professional Health IT community to work medication data

Background

• We started discussions, but scope grew out of hand

• So we split the scope, allowing for discussions on medication lists.

• We reached some conclusions.

Panorama today

• PCC refers to medication list. – Which for most common clinical cases is sufficient

• But several initiatives are looking beyond those cases– Pharmacovigilance– Several cases (adherence,

The track was hard, but right

• PML is the only container for supporting “all” data about medication.– Prescribed– Dispensed– Administered– ...?

• We have seen that all of these are different.– Or have we? Work challenge 1

Meanwhile...

• Several lists exist. Even without focusing on “active” vs “current”, the disparity is obvious

• Some lists consider prescribed medications, others dispensed. Some mix “ordered” with “administered”.

Interoperability mechanisms are NOT interoperable (!)

• Blue Button+• HL7 Immunization IG• IHE HMW• IHE CMPD• HL7 Medication Statements• NCPDP list

• IHE PML

But...

• ISO is working on Medication Repositories.– Same recipe: Capture Prescription, Dispense,

Administration data.

• Literature suggests that this data provides best value when “groomed”

Outcome

• A simple guidance to understand – What can Medication data consist of– Medication data exists in several places along a

patient’s history.– What standards exist to capture medication data– How can medication information can be captured

from these places.

• Justification of an interoperability mechanism for exchanging medication lists

Medication Documentation interoperability

NCPDP LIST

CCR

IHE Pharm

Others

HL7 Immunization IG

Dispensed

Ordered

Administered

othersUsing this interoperability model, each dimension has its

clear meaning and expected data.

Data can be decomposed in its

Components.

Dispenses are dispensesOrders are orders

Several models co-exist

Any data exchange will preserve the original meaning

NCPDP LIST contains DISPENSED medications

(TBC)

CCR informs “Prescribed”

medication (TBC)

IHE handles prescription, dispense and administration

separately

Immunization contains Planned and Administered

• These differences in the data about medication – Are trivial to us, but not for others– Enable many more uses of data towards patient

safety.

Moving on...

• Not really focus on “what is in a list”

• But focus on scenarios like– Patient has medication and vaccination history across

countries– Patient has history of poor adherence– Population & other analyses

• Enable systems to provide the data in several forms.

In other words

• What data is needed for making the medication data warehouse?

• Aka the master repository that can collect and reconcile all data

• It is already being done....