Medication Documentation Challenges and first impressions José Costa Teixeira October 2014

Goal Exchange proper Medication Data, (instead of Medication Lists). Exchange – Focus on interoperability Proper – exchange data that is clear Medication 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 others Using this interoperability model, each dimension has its clear meaning and expected data. Data can be decomposed in its Components. Dispenses are dispenses Orders 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....