1. ConnectingOntario ClinicalViewer
Medications Portlet
Trainers Guide
CO_Train_20_TrainersGuide_MedicationsPortlet_V_A_v01.potx

2. Use of this slide deck
eHealth Ontario encourages the use of the materials as they are designed for the education and training of users of the ConnectingOntario ClinicalViewer. You are permitted to customize these materials according to your organization’s learning needs with the following exception:
You must not change any messaging or wording regarding DHDR as it pertains to the Medications portlet. Any changes require approval from the Ministry of Health and Long-Term Care (MOHLTC). Contact for more information.
This Trainer’s Guide contains key messages which are required for end-user education and provides supplemental information to enhance trainer knowledge

3. Agenda Medications Portlet – End User Training Overview
Digital Health Drug Repository (DHDR) information
Privacy/Training requirements
Key messages
How to use the portlet
Consent management
Clinical use of DHDR information
Help Desk Workflow
Education/training materials and resources

4. Overview
Integration of ConnectingOntario and Digital Health Drug Repository
The province’s Digital Health Drug Repository (DHDR) is being integrated with ConnectingOntario in Release 9.1
This information will display in a new Medications Portlet – Dispensed Medications tab expanding access to valuable patient information for health care providers’ clinical decision-making in the ConnectingOntario ClinicalViewer

5. Overview Digital Health Drug Repository
The Dispensed Medications tab displays information from the Digital Health Drug Repository (DHDR) for Ontarians with an Ontario Health Number. This includes:
Publicly funded drugs and pharmacy services (including monitored drugs)
Reflects information the dispensing pharmacy submits to the Ministry of Health and Long-Term Care for reimbursement
As of May 2017, includes approximately 7 years of information about:
Drugs paid for by the Ontario Drug Benefits (ODB) program. The ODB program includes the Trillium Drug Program (TDP)
Most publicly funded drugs paid for by other public drug programs (e.g. Special Drugs Program - SDP)
Publicly funded pharmacy services (e.g. MedsCheck), some of which are available to all Ontarians, some to ODB program recipients only
Narcotics Monitoring System (NMS) information
As of May 2017, includes approximately 5 years of information about monitored drugs (narcotics and controlled substances), dispensed in Ontario, regardless of payor, when the approved identification used was a valid Ontario Health Number

6. Overview Digital Health Drug Repository DHDR data is limited to:
Information that the ministry has the authority to disclose under the terms of the Personal Health Information Protection Act, 2004 (PHIPA) and the Narcotics Safety and Awareness Act, 2010 (NSAA)
Information that has been submitted to the Health Network System to date in respect of the drug and pharmacy service data described in section 3.1(DHDR Health Care Provider Guide)
DHDR provides more information than what is available in the Drug Profile Viewer (DPV) (Refer to Tip sheet: Dispensed Medications and DPV Comparison)
For more information about DHDR visit and Information Available to Health Care Providers through the Digital Health Drug Repository
Other limitations described later and in Tip sheet: Dispensed Medications Guide for Clinical Use

7. Overview Benefits of Digital Health Drug Repository to Providers
Access to clinically relevant drug and pharmacy service information enabling the Best Possible Medication History (BPMH);
Better integration of available drug data through existing EMRs, provincial digital health assets and other systems to quickly, securely and efficiently access data to enable the BPMH;
Enhanced patient safety and continuity of care
Improved collaboration between health care providers through the sharing of patient clinical data

8. Overview Benefits of Digital Health Drug Repository to Patients
Enhanced patient experience with the health care system since care will be provided by better informed health care providers
Improved patient-centred care by providing health care providers secure electronic access to a patient’s drug and pharmacy service information and allowing them more time for diagnosis, treating and communicating with the patient
Improved patient outcomes and decreased risk of adverse drug events

9. Overview Benefits Realization
As of May 2017, 41 sites have access to DHDR in ClinicalConnect in South West Ontario
Survey of Guelph General Hospital (GGH) Emergency department (ED) physicians shows that DHDR assists in the following:
Ensures meds are continued during transitions of care
Improves quality of care provided
Identifies drug-seeking behaviour
Identifies harmful drug interactions
Monitors patients’ compliance

10. Overview Testimonials and examples
GEM [Geriatric Emergency Medicine] nurses find the DHDR enables a faster, more reliable BPMH process Emergency Department discharge especially for elderly patients for whom narcotics can be a high risk medication
“Helpful for patient presenting with undifferentiated drug overdose to determine prescribed medications and possible interactions or side effects.” – ED Physician, GGH
“Currently, all dispensed narcotics are in DHDR, so I can feel comfortable that if the narcotic prescription does not appear, the patient likely is not actually on it. The DHDR helps me be a more responsible prescriber.” Dr. Finnigan, Family Physician, Guelph Family Health Team

11. Training Requirements
Medications Portlet and Digital Health Drug Repository
As the Health Information Custodian (HIC) for the DHDR, the Ministry of Health and Long-Term Care (MOHLTC) requires end-users to be educated/trained prior to accessing the information; the method of training is not prescribed, only the communication of key messages
The user must also have completed appropriate privacy training consistent with existing requirements for accessing the ConnectingOntario ClinicalViewer
Key training messages:
Information available in Dispensed Medications
Limitations and clinical use of Dispensed Medications information
Consent requirements (i.e., informed consent, wet signature)

12. Accessing the Medications Portlet
Medications portlet displays on the first level or row in Summary View
The full-sized individual portlet is accessed by clicking the Medications portlet icon in the Navigation bar
The Visits/Encounters portlet now displays in the second level, pushing the Diagnostic Imaging and Other Results portlet to the right. The Community Portlet displays on a third level. The user’s screen resolution will determine how much vertical scrolling is required to view the Community portlet
Medication Portlet in Summary View

13. Reference for DHDR Information
Header and Data Summary
Dispensed Medications tab has been added to the Data Summary
This tab contains a link to the MOHLTC’s website which outlines the information available within the Digital Health Drug Repository
Click for hyperlink

14. Medications Portlet Tabs
Dispensed Medications Tab
DHDR information displays in the Dispensed Medications tab
Medications portlet behaves as other portlets in ClinicalViewer
More columns display in the Summary List view or Individual Portlet
Dispensed Date (reverse chronological) is used for the default sorting order
Standard Consent Directive and Override messages appear when directive is in place
Sort and Filter is available on all the columns

15. Medications Portlet Dispensed Medications Views
Medications information is available in:
Summary View (Condensed Portlet)
Summary List View ( Full-size)
Individual Portlet (Full-Size)
Details Screen (Displayed in Summary List View and Individual Portlet)

16. Summary View Default/Mandatory columns:
Dispensed Date
Generic Name
Brand Name
Strength
Form
Quantity
Customizable columns (click on to add columns:
Est. Days Supply
Prescriber
Prescriber ID
Pharmacy
Therapeutic Class
Sub Classification Name
Drug Utilization Review (DUR) indicator is displayed next to the Generic Name; details for DUR are displayed in Details screen in Summary List View or the Individual Portlet

17. Summary List View 1. Portlet Name 2. Dispensed Medications Tab Name3 4 6 5 7
1. Portlet Name
2. Dispensed Medications Tab Name
3. Disclaimer
Links to Information Available to Health Care Providers through the Digital Health Drug Repository
4. Summary List View Data Fields
5. Drug Utilization Review Indicator
6. Data Source – Digital Health Drug Repository displays in hover over
7. Number of Results Returned

18. Summary List View Default/Mandatory Columns:
List of medications for the selected period can be printed from the individual portlet or summary list view using the Print icon
Default/Mandatory Columns:
Dispensed Date
Generic Name
Brand Name
Strength
Form
Quantity
Est. Days Supply
Pharmacy
Prescriber
Prescriber ID
Customizable columns (click on to add columns:
Therapeutic Classification
Sub Classification Name

19. Dispensed Medications
Printing
Printing is available from the Summary List or Individual Portlet view only
Customizable columns can be printed only if added to the portlet

20. Drug Utilization Review Indicator
Note: A name which is truncated may have a DUR indicator which is not visible. To view:
Extend the column header, or,
Select the row to view in the Details screen below
Drug Utilization Review information is historical information from DHDR on DUR alerts that were communicated to the pharmacy when the drug claim was submitted for payment
DUR information is displayed in the Details Screen:
Reason for DUR (Alert Type): e.g., drug/drug interaction potential
Action taken: action by pharmacist in response to the DUR alert
Additional information: includes severity level of the drug to drug interaction
Note: At this time, historical DUR alert information is limited to drug to drug interactions between publicly funded drugs contained in the DHDR

21. Details Screen Summary List View or Individual Portlet View1 2 3 4 5
To view the DUR details for a result,
Click on a result to select it
Scroll down to the Details screen
View DUR information at bottom left of screen
Printing of the Details screen is not available in this release
Drug Information
Additional Drug Information
Prescriber Information
Pharmacy Information
Drug Utilization Review – Reason for DUR, Action Taken, Additional Information

22. Details Screen Displayed Information Fields (Reference Information)
Dispensed Date
Generic Name
Brand Name
Strength
Form
Quantity
Est. Days Supply
DIN/PIN
Therapeutic Class
Sub Classification Name
Prescription Number
Medical Condition/ Reason for use
Drug Information
Additional Drug Information
Prescriber
Prescriber Phone Number
Prescriber ID
Prescriber ID Reference
Pharmacy
Pharmacy Phone Number
Pharmacist
Reason for DUR
Action Taken
Additional Information
Prescriber Information
Pharmacy Information
Drug Utilization Review

23. No Patient Information Available
Messages Displayed in Portlet
Dispensed Medications information is available only for Ontarians who have a valid Ontario Health Number (HN)
For patients without an Ontario HN, a yellow warning banner will appear
DHDR may contain no data for a patient during the selected timeline. In this case, “No results available” is displayed in place of the results count message

24. Medications Portlet
Consent Management for all Portlets in ConnectingOntario ClinicalViewer
Note:
An override in the ConnectingOntario ClinicalViewer will result in all portlets with a consent directive to be unmasked. Although the data in the Dispensed Medications tab may not be required to provide care, an override in another portlet will also release this data and you must complete the express consent form in addition to the Consent Override Dialogue box
Risk of Harm overrides will not unmask information in the Lab and Pathology Portlet or Dispensed Medications tab

25. Medications Portlet
Consent Management for all Portlets in ConnectingOntario ClinicalViewer
Before you perform an override on any portlet in the ConnectingOntario ClinicalViewer:
Confirm if a block is placed on the Dispensed Medications tab. If it is blocked, you must print a hard-copy express consent form. This can be obtained from the Consent Directive Dialogue Box
Inform patient or substitute decision maker (SDM):
the reason for overriding consent
the override will apply to any other information or portlet where a block has been applied
they may refuse to permit the override
the information will be available:
If the patient agrees to the override and the Dispensed Medications tab is blocked, obtain consent and document the receipt of consent by requesting a signature from the patient or substitute decision maker on the express consent form and complete the Consent Directive Dialogue Box
Data Source
Duration and Users Who May Access
ConnectingOntario Clinical Data Repository (All portlets except Lab and Pathology and Medications-Dispensed Medications)
Up to 11:59pm on the day that the override was initiated to the user that requested the override.
Lab and Pathology Portlet: Ontario Laboratories Information System (OLIS) and Dispensed Medications: DHDR
Available for 4 hours to all users at the organization or practice where the override occurred.

26. Medications Portlet Consent Management for DHDR
Patients may place a consent directive to block all records in DHDR
Temporary consent override is available in the Dispensed Medications tab (i.e., DHDR)
The MOHLTC requires all users who override a consent directive in DHDR to print a hard-copy express consent form and receive a signature from the patient or substitute decision maker
This form may be printed from the Consent Override Dialogue box directly from the ConnectingOntario ClinicalViewer and should be retained as part of the patient’s record
A consent directive override without patient or Substitute Decision Maker (SDM) explicit consent for access to DHDR data is not permitted
A consent directive override for risk of harm is not permitted

27. Medications Portlet Consent Management
When a consent directive is in place on the Medications Portlet, the standard messaging and override button appear 1 2
Override Consent Button
Before Consent Override Warning Message
Express consent from the patient or substitute decision maker is required for unmasking of DHDR information. This includes informing the patient or SDM:
the reason for overriding consent
DHDR information will be displayed for four hours to all users at the organization where the override occurred
the override will apply to any other information or portlet where a block has been applied
they may refuse to permit the override

28. Medications Portlet Requirements for Consent Override for DHDR
After clicking the Override Consent button, the Override Consent window displays
The provider completing the override must print the required consent form, obtain the patient or SDM’s signature and retain the consent form for audit purposes
A link to the consent form is available in the Override Consent window and in the ClinicalViewer header’s Applications menu
Consent directive override for Risk of Harm is not permitted

29. Medications Portlet Requirements for Consent Override for DHDR
Consent Form

30. Medications Portlet Consent Management for DHDR1
1. After Consent Override Warning Message: appears when blocked information is unmasked
When a consent directive override is performed
The DHDR information will be viewable to any user at the health information custodian organization for a 4-hour period
The patient will receive notification from the MOHLTC whenever their consent directive in DHDR is overridden
The Privacy Officer at your organization will receive an from the eHealth Ontario Privacy Office to investigate the access. The Privacy Officer will verify express consent was received by the individual for access to DHDR by reviewing the express consent form

31. Privacy and Patient Inquiries and Requests
Informing Patients and Substitute Decision Makers
MOHLTC has undertaken a broad public notice campaign to inform Ontarians of the disclosure of their drug and pharmacy service information with all health care providers for the purpose of providing care. This campaign included:
Notice to Ontarians published in several daily, multicultural and indigenous newspapers
Notice to Patients posted at all pharmacies in the province, refer to slide 32
Poster and Patient handouts are available on the MOHLTC website: Notice to Ontarians
Direct patients to ServiceOntario INFOline toll-free at (TTY: ) for all:
privacy-related inquiries or complaints
requests for corrections to his/her drug and pharmacy service information in the DHDR
requests to find out who in Ontario has accessed his/her drug and pharmacy service information via the DHDR in a given timeframe
requests regarding what drug and pharmacy service information the MOHLTC makes available through the DHDR
requests to block or unblock access to his/her information in the DHDR (consent directive)

32. Notice of Disclosure
(on Ministry website
and newspaper ads)

33. Notice to Patients
“Yellow Poster”
(in All Pharmacies)

34. Clinical Use of DHDR Information
Limitations of Data - Considerations
DHDR information is advisory only and is not intended to replace sound clinical judgment
It may not represent a patient’s complete medication history as it may not include
all the current medications a patient is taking at any time, or
all the pharmacy services that a patient has received

35. Clinical Use of DHDR Information
Limitations of Data - Considerations
Key considerations include:
the information should be discussed and confirmed with the patient or other source(s)
the patient may not have picked up their medications or may not be taking them as prescribed
the patient may be taking other medications such as over-the-counter or privately-paid medications (excluding narcotics and controlled substances)
it does not include hospital-dispensed medications
it does not reflect details such as:
whether a prescription is new or a refill
changes to drug therapy (e.g., discontinued, dosage)
current use of medication
instructions for use (e.g., frequency)
Contact the dispensing pharmacy or prescriber for additional information or clarification

36. Clinical Use of DHDR Information
Limitations of Data – Important Term Descriptions
Dispensed Date: transaction date when the prescription drug was dispensed or the pharmacy service was rendered; it does not indicate if the medication was picked up
Strength: strength of the prescription drug dispensed, amount of active ingredient in the drug; for topical and liquid medication it may be shown as a percentage or ratio
Quantity: quantity of medication dispensed; may be the number of items dispensed, or, for topical and liquid medication (e.g., Methadone) it may refer to dose, total volume or volume of drug concentrate
Estimated Days Supply: estimated days of treatment based on the directions for use on the prescription, and/or the pharmacist’s judgment on usage; estimating usage accurately may not be possible for some prescriptions (e.g., PRN)

37. Clinical Use of DHDR Information
Limitations of Data- Clinical Example
DUR information if available is displayed in the Details screen of the Medications portlet
Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet
Example of Printed Medication List
Use caution extrapolating the frequency from the Quantity and Estimated Days Supply
Based on the example above, 90 tablets of Metoprolol 50 mg was filled for an estimated 30 days supply. (Quantity / Estimated Days Supply) = 3 tablets per day. The instructions may have been 75 mg (1.5 tablets) twice a day, 50 mg (1 tablet) three times a day or another variation. Estimated Days Supply may not be accurately estimated, further compounding the problem

38. Clinical Use of DHDR Information
Limitations of Data- Clinical Example
DUR information if available is displayed in the Details screen of the Medications portlet
Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet
Example of Printed Medication List
The DHDR does not indicate if a prescriber intended current use of a medication
The patient may have been instructed to take Metoprolol and Verapamil together, stop one and continue the other, or stop both
Changes to medication therapy are not known
The patient may have been given alternate dosing instructions (e.g., to decrease the Metoprolol dose to 25 mg (0.5 tablet) three times a day)

39. Clinical Use of DHDR Information
Limitations of Data- Clinical Example
DUR information if available is displayed in the Details screen of the Medications portlet
Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet
Example of Printed Medication List
The DHDR reflects an historic record of drug and pharmacy service information. There is no functionality for medications to be marked as discontinued, placed on hold, or to record adverse events or allergies. It cannot be assumed from the appearance of a record that a patient was successfully treated or can tolerate a specific medication

40. Local Help Desk Support
Updates and DHDR support

41. Local Help Desk Support
DHDR Support
All DHDR calls for privacy should be directed to ServiceOntario INFOline with the exception of:
If you are a health care provider and would like to request a correction to your provider information associated with a DHDR record (e.g. missing or incorrect prescriber / pharmacy information) please contact the eHealth Ontario Service Desk at
If you require DHDR audit reports: Contact the eHealth Ontario Service Desk at and request an audit report by user or audit report by organization. The eHealth Ontario Service Desk will open a ticket on your behalf
Any tickets sent to eHealth Ontario Service Desk where PHI is required for the ticket must be zipped and encrypted to minimize exposure of PHI
Do not send PHI unless necessary
Follow File Encryption and Transfer Guideline (refer to ConnectingOntario Operations Guide for Site Help Desks or DHDR Health Care Provider Guide)
Refer to eHealth Ontario Service Interaction Guide and DHDR Site Support Guide

42. Education and Training Resources
Medications Portlet
Resources available at (Documents and Training section)
Messaging regarding DHDR can not be modified without Ministry approval
Tip sheets:
How to Use Medications Portlet
Medications Portlet: Dispensed Medications Guide for Clinical Use
ConnectingOntario ClinicalViewer – Dispensed Medications and Drug Profile Viewer (DPV) Comparison
Help Desk Workflow (revised)
Data summary (revised)
Guides: (DHDR guides available at
DHDR Health Care Provider Guide
DHDR Site Support Guide
eHealth Ontario Service Interaction Guide
ConnectingOntario Operations Guide for Site Help Desks
MOHLTC website
FAQ’s
Notice to Ontarians
Reference: Information Available to Health Care Providers through the Digital Health Drug Repository

43. Education and Training Resources
Medications Portlet
Toolkit Materials:
Medications Portlet: Trainer’s Guide
Medications Portlet: End-User Presentation
Medications Portlet: Demo video (TBD)
Questions?
Support? Contact: eHealth Ontario Service Desk Toll Free: