IHE Pharmacy domain Medication Documentation A structured genealogy of the way into chaos … Jürgen Brandstätter IHE Pharmacy co-chair

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 patients body Can 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 are the pitfalls in Community Pharmacy We dont know for sure if the patient actually takes the medication he should take We dont know for sure what else the patient takes We dont know for sure how long ingredients are active We know and accept it … and dont care about it from now on

Hopeful in the beginning Pharmacy meeting at Connectathon in Pisa 2011 The solution seems near: Lets 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 rule

Overwhelmed right after Looking around: Who deals with that? HL7 Pharmacy AustraliaAustralia IHE PCC ASTM CCR HL7 CCD CEN US (NCPDP) AustriaAustria NetherlandsNetherlands UKUK IHE Pharmacy …… ……

Realistic after 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: We needed a Whitepaper

Chaotic at 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 at 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 at 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: Phycisians view Medication profile: Pharmacists 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

Silverline 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? 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 PrescriptionPrescription Pharm. Advice DispenseDispense PrescriptionPrescription DispenseDispense … Workflow Medication Therapy Medication Order PrescriptionPrescription

Link 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_ /Technical%20Committee/WhitePapers/Medi cationDocumentation/IHE_Pharmacy_WhitePaper _Medication_Documentation_v09.doc ftp://ftp.ihe.net/Pharmacy/yr2_ /Technical%20Committee/WhitePapers/Medi cationDocumentation/IHE_Pharmacy_WhitePaper _Medication_Documentation_v09.doc

Discussion Please tell us … … what do you think?

Links Technical Frameworks Pharmacy Wiki Strategic planning page Roadmap Committees Google group

Thank you Jürgen Brandstätter IHE Pharmacy co-chair, IHE International Board, IHE Austria Board CodeWerk Software Services and Development GmbH