IHE Pharmacy domain Profiles for Community and Hospital Pharmacy Jürgen Brandstätter IHE Pharmacy co-chair

Pathology since 2006 Radiation Oncology since 2004 Radiology since 1998 Cardiology since 2003 Patient Care Devices since 2005 Patient Care Coordination since 2005 Eye Care since 2006 Quality Research & Public Health since 2007 Laboratory since 2003 (Healthcare) IT Infrastructure since 2003 since 2008 Pharmacy within IHE landscape Pharmacy since 2008

Pharmacy (PHARM)  “IHE Pharmacy addresses information sharing, workflow and patient care in both community and hospital pharmacies.”  Most actively involved … Many European countries USA/Canada Australia  1 whitepaper, 5 profiles  Whitepaper work on certain (rather complex) topics  Sponsors & Supporters EAHP NICTIZ Réseau Phast IHE Pharmacy overview

Cover the overall process from prescription at the GP to dispense at the Pharmacy Our needs in community

Cover the overall medication workflow from prescription via validation and dispense to the administration to the patient Our needs in hospital

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

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 Meetings are F2F and TCons  Just join in! Participate IHE’s Profile Cycle How to participate in Pharmacy …

ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.2.pdf What has been done? IHE White Paper   Foundation of all current profiles Final version   Released in early pages   Community Pharmacy use cases   Hospital Pharmacy use cases   Harmonization of actors definitions

What has been done? 5 profiles for …  … Community Pharmacy CMPD Community Medication Prescription and Dispense PRE Content Profile: Medication Prescription PADV Content Profile: Pharmaceutical Advice DIS Content Profile: Medication Dispense  … Hospital Pharmacy HMW Hospital Medication Workflow

IHE Pharmacy – Key process Validation of the prescription (ICA check)

Common Data Model Data Model describe the data elements and their relations Common for hospital pharmacy and community pharmacy Derived from the model: HL7v2 messages and CDA documents  HL7v2, Version 2.5/2.6  HL7v3 CDA HL7v3 Pharmacy CMETs

cycle CMPDPREPADVDIS HMW

Existing Profiles with High Uptake CMPD (Community Medication Prescription and Dispense)  Basic use case GP prescribes Pharmacist validates the prescription Community pharmacist or pharmacy dispenses  Systems it would impact: Prescription placer module in GP systems Pharmaceutical validation software Pharmacy software  Based on IHE ITI XDS: Strong integration with existing CDA/XDS- based solutions + PRE Medication Prescription + PADV Pharmaceutical Advice + DIS Medication Dispense Community Pharmacy profiles

CMPD actor diagram

CMPD Workflow scenario Pharmaceutical Adviser Prescription Placer Medication Dispenser Ordering Dispensing PHARM-1, Query: FindPrescriptionsForDispense Prescription document contains at least one Prescription Item ready to be dispensed. A Prescription Item is ready to dispense if there exists a Pharmaceutical Advice Item related to it which has statusCode set to “completed” and code=OK or CHANGE. Validation PHARM-1, Query: FindPrescriptionsForValidation Next task: „Validation“ Next task: „Ordering“ Condition: Always Condition: if PADV exists with statusCode=completed AND code=OK or CHANGE Condition: if PADV exists with statusCode=completed AND code=REFUSE Stop Condition: if PADV exists with statusCode=completed AND code=CANCEL Next task: „Dispensing“ Prescription document contains at least one Prescription Item ready to be validated. A Prescription Item is ready to validate if there exists no Pharmaceutical Advice Item related to it which has statusCode set to “completed”.

Content Profiles Content Profiles define „payload“ of CMPD system  PRE  PADV  DIS Based on HL7v3 CDA extended by HL7 Pharmacy CMETs

Existing Profiles with High Uptake 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 nodules Validation software Medication dispensing systems Medication administration informer modules  Based on HL7 v2.5/v2.6: Message based to fit into hospital environment 8/8/ Hospital Pharmacy profiles

HMW actor diagram

HMW Interoperability Model

Becoming real … European Union: epSOS  12 member states (extended in epSOS 2)  Definition of prescription and dispense document are (almost) in sync Austria / Europe: e-Medication project  Adoption of PRE und DIS specifications in pilot  Full adoption of CMPD for rollout (8 million inhabitants) Italy / Europe: DOGE project  Venice region (5 million inhabitants)  21 Local Health Authorities, 2 Hospital Trusts, GPs, community pharmacies  Fully adopt CMPD and Content Profiles

Future / Roadmap Current work-items  Medication record Aka „Medication documentation“ / „Medication treatment plan“ Cross-domain work with other IHE domains and HL7  Exceptional cases Extension of use-cases in CMPD and HMW  Whitepaper: Supply chain in Hospital Pharmacy  Whitepaper: Transition „Community – Hospital“  Automatic administration by Infusion pumps Cross-domain work with IHE Patient Care Devices domain  Common Glossary Cross-domain work IHE and HL7 Upcoming work-items  HL7v3 messages  Prescription of non-medication products

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

Thank you Jürgen Brandstätter IHE Pharmacy co-chair CodeWerk Software Services and Development GmbH