Jürgen Brandstätter, MScCo-chair Pharmacy Planning committee

Co-chair Global Deployment Coordination Committee (GDC)

IHE International Board

CodeWerk Software GmbH, Austria

• IHE Pharmacy Domain Update

Webinar

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

What is IHE?

eHealth Projects

IHTSDO

IETF

Standards

?Use cases typically require„combinations“ of standards

- but how to compose?

What is IHE?

eHealth Projects

IHTSDO

IETF

Standards Profiling and Testing

Products

Projects

IHE methodology

Use Case

Identify available standards

Profile Development

Testing at Connectathons

Products declare

IHE

Easy to integrate products

RFPs with IHE

reqs

IHE: Difference to classic SDO

• Classic Standards Developing OrganizationDevelops „future“ standards in certain areas

• IHEUses „existing“ standards to profile Interoperability use-cases

IHE is a non-profit association dedicated to interoperability in health information technology.

IHE: A forum for agreeing on how to implement standards and processes for making it happen

Pharmacy within IHE landscape

Pathologysince 2006

Radiation Oncologysince 2004

Radiologysince 1998

Cardiologysince 2003

Patient Care Devicessince 2005

Patient Care Coordinationsince 2005

Eye Caresince 2006

QualityResearch & Public Health

since 2007

Laboratorysince 2003

(Healthcare)IT Infrastructure

since 2003

since 2008

Pharmacysince 2008

IHE Dental

IHE Endoscopy

Our needs in hospital

Cover the overall medication workflow from prescription via validation and dispense to the

administration to the patient

Our needs in community

Cover the overall process from planning medication and

prescription at the GP via dispense at the Pharmacy to ambulant

administration

IHE Pharmacy overview

Vision: “Pharmacy processes runs seamless in the community and hospital domain as well as cross-domain.”

Mission: “IHE Pharmacy produces profiles and guidance that addresses information sharing, workflow and patient care in both community and hospital domain.”

Most actively involved …• Many European countries• USA/Canada• Australia

1 whitepaper, 6 profiles, Whitepaper work on certain (rather complex) topics

Sponsors & Supporters• EAHP, NICTIZ, Réseau Phast

Strategic goals

• Promote widespread adoption and implementation of IHE Pharmacy developed profiles by ...

• Marketing and promoting the profiles globally• Reaching out for national/regional e-Prescription programs in order to

• (1) learn requirements and demands which lead to developments within IHE Pharmacy and

• (2) stimulate leveraging of IHE Pharmacy profiles as basis for their national specifications

• Improve information exchange between healthcare providers and organizations that depend on Pharmacy related workflows and processes

• Develop ways to automate collaborative workflow between physicians and pharmacists in both community and hospital pharmacy environment

• Establishing and maintaining collaboration to ...• other IHE domains• HL7 Pharmacy• ISO TC215 WG6 Pharmacy• NCPDP

Big success: European Commission recognizes 27 IHE profiles that “should be referenced in

public procurement documents”1)

-> 2 Pharmacy profiles included (PRE, DIS)!

1) http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

Liaisons

ISO TC 215 WG6 „Pharmacy“ / CEN TC 251Global recognition

HL7 PharmacyBase Standards

IHE PharmacyProfiling Layer

Friendly collaboration

Liaisons

ISO TC 215 WG6 / CENGlobal recognition

HL7 Pharmacy Base Standards

IHE PharmacyProfiling Layer

Contributions

User/Vendor Input

ISO Standards

Base and legal binding standards

Liaisons

ISO TC215 WG6 / CENGlobal recognition

HL7 PharmacyBase Standards

IHE PharmacyProfiling LayerProjects

High-level

TechnicalProfiles

(Use Cases) HL7 Standards

ISO Standards

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

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

What has been done?

• 7 profiles for …

… Hospital Pharmacy• HMW Hospital Medication Workflow

… Community Pharmacy• CMPD Community Medication Prescription and Dispense• PRE Content Profile: Medication Prescription• PADV Content Profile: Pharmaceutical Advice• DIS Content Profile: Medication Dispense• PML Content Profile: Pharmacy Medication List• MTP Content Profile: Medication Treatment Plan1)

1) Currently in publishing process

The White Paper…

• IHE White Paper

Foundation of all current profiles

• Final version

Released in early 2010

• 78 pages

Community Pharmacy use cases Hospital Pharmacy use cases Harmonization of actors definitions

Current version: ftp://ftp.ihe.net/Pharmacy/White%20Paper/IHE_Eur_Pharmacy_White_Paper_Final_Text_1.3.3.pdf

IHE Pharmacy – Key process

Prescription

Specialist, GP

Pharmaceutical advice

Pharmacist

Dispense

Pharmacist

Administration

Patient, Nurse, Family member

Rejected Repeat dispense

Dispensed

Approved Prescribed

Clinical result of medication

Validation of the prescription(ICA check, etc.)

Hospital Pharmacy profile

Workflow and Content

Hospital Medication Workflow (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 modules• Pharmacy (Validation, encoding…) software• Medication dispensing systems• Medication administration informer modules

– Based on HL7 v2.5/v2.6:• Message based to fit into hospital environment

HMW Interoperability Model

HMW Interoperability Model

Medication Dispenser

(supply and distribution are covered, but not profiled yet)

Community Pharmacy profiles

Workflow

Community Medication Prescription and Dispense (CMPD)

•Technical Integration, Actors, Transactions, based on IHE ITI XDS

Content (based on HL7v3 CDA extended with HL7 Medication CMETs)

Prescription (PRE)• In sync with upcoming ISO DTS 17523

“Requirements for electronic prescriptions”and ePrescription guideline of the EU / eHGI

Dispense (DIS)• In sync with upcoming ISO DTS 19293

“Requirements for the record of DispenseMedicinal Products”

Community Pharmacy profiles

Content (based on HL7v3 CDA extended with HL7 Medication CMETs)

Pharmaceutical Advice (PADV)• Used for …

– Validating a prescription» e.g., Medication Interaction Checking Issue

Management– Managing of prescriptions and dispenses (Change,

Cancel, …)» Always related to PRE, DIS or MTP

Pharmacy Medication List (PML)• Information on prescribed and dispensed medication to a

patient• Contains Prescription-, Dispense-, Pharmaceutical Advice Items• „On-demand“ document

Medication Treatment Plan (MTP)• Information on planned medication to a patient• Contains Medication Treatment Plan Items (alike PRE items)• Prescriptions and Dispenses may be referencing MTP

CMPD actor diagram

Create Prescriptions/Dispenses

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]S

eHe

Rep

osi

tory

[SeH

e Sy

stem

]

SeH

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare Provider prescribes

in local HISStart

Store prescription

End

PrescriptionPrescription

Prescription document is

created by local HIS

Prescription document is printed and handed out to

patient

Dis

pen

ser

[PH

C, H

ospi

taL

Pha

rmac

y, e

tc.]

Dis

pen

ser

[PH

C, H

ospi

taL

Pha

rmac

y, e

tc.]

Seh

e R

epo

sito

ry[S

eHe

Syst

em]

Seh

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare Provider records the DIspensation

Record in local HISStart

Store Dispensation

End

Dispensation Dispensation

Dispensation is created by local

HIS

Medication is dispensed to the patient

CreatePrescription

Create Dispense

Create Prescriptions/Dispenses

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]S

eHe

Rep

osi

tory

[SeH

e Sy

stem

]

SeH

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare Provider prescribes

in local HISStart

Store prescription

End

PrescriptionPrescription

Prescription document is

created by local HIS

Prescription document is printed and handed out to

patient

Dis

pen

ser

[PH

C, H

ospi

taL

Pha

rmac

y, e

tc.]

Dis

pen

ser

[PH

C, H

ospi

taL

Pha

rmac

y, e

tc.]

Seh

e R

epo

sito

ry[S

eHe

Syst

em]

Seh

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare Provider records the DIspensation

Record in local HISStart

Store Dispensation

End

Dispensation Dispensation

Dispensation is created by local

HIS

Medication is dispensed to the patient

CreatePrescription

Create Dispense

Medication Interaction Checking

Manage Prescriptions/DispensesP

resc

rib

er[P

HC

, Hos

pita

l, et

c.]

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]S

eHe

Rep

osi

tory

[SeH

e Sy

stem

]

SeH

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare provider manages the

Prescription Item in the local HIS

Start

Store the update to the prescription

End

UpdateUpdate

Update document is created by local HIS

Manage Prescriptions/Dispensations

Manage Prescriptions/DispensesP

resc

rib

er[P

HC

, Hos

pita

l, et

c.]

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]S

eHe

Rep

osi

tory

[SeH

e Sy

stem

]

SeH

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare provider manages the

Prescription Item in the local HIS

Start

Store the update to the prescription

End

UpdateUpdate

Update document is created by local HIS

Manage Prescriptions/Dispensations

Medication Interaction Checking

Query/Retrieve Medication Documents

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]

Pre

scri

ber

[PH

C, H

ospi

tal,

etc.

]S

eHe

Rep

osi

tory

[SeH

e Sy

stem

]

SeH

e R

epo

sito

ry[S

eHe

Syst

em]

Healthcare provider sets query parameters and initiates the query for

prescriptions in the SeHe Repository

Start

Query prescriptions

End

PrescriptionPrescription

Processing of the prescription and related

documents by local IT system

Healthcare provider identifies the prescription

in the search result

Retrieve prescriptionand all related documents

Related documents

(e.g., Dispensation

Records)

Related documents

(e.g., Dispensation

Records)

The way of a prescription

PRE

Physician prescribes a

prescription with 5 prescription items

PI 1

PI 2

PI 3

PI 4

PI 5

PADV

The way of a prescription

PRE

Physician changes PI 1

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1PADV

PADV 3

Physician cancels PI 3

PADV

The way of a prescription

PRE

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1

Pharmacist dispenses all PIs

DIS

DIS 1 DIS

DIS 2

DIS

DIS 4 DIS

DIS 5

PADV

The way of a prescription

PRE

PI 1

PI 2

PI 3

PI 4

PI 5

PADV 1

Physician changes dosage of DIS 2

and instructs the patient to stop intake of DIS 5

DIS

DIS 1 DIS

DIS 2

DIS

DIS 4 DIS

DIS 5

PADV

PADV 2

PADV

PADV 5

Planning / Actual

PRE DIS DISPADV

Change

Plan

Actual

Action

Physician starts

medication treatment

Physician changes dosage

Patient runs out of medication

s

Physician changes dosage again

Logical flow Leads to

PRE DIS

MTPPADV

ChangePADVChange

Reference to MTP Reference to PRE Reference to DIS

Time

…

Becoming real – in epSOS

European Patient Smart Open ServicesGoals (relevant for IHE Pharmacy)

• Cross-border prescription and dispense• Demonstrated in pilot use

Covered use-casesPrescription query (cross-border)Dispense create (cross-border)

Community Pharmacy profiles usedContent: PRE, DIS

Synced1) Concept derived from epSOS2) Worked in sync with epSOS3) Further elaborated in IHE

Becoming real – in Austria

Austrian e-Medication projectGoal of the project

• Increasing patient safety by providing a “Medication List” of a patient for physicians and pharmacists to support prescribing and medication interaction checking

•Nation-wide rollout (8 mio people): All physicians and pharmacists will be connected•Rollout and startup on volunteer basis 2016, mandatory use for physicians and pharmacies starting 2017

To achieve the goal …•… prescriptions and dispenses have to be captured electronically to act as data-source for the medication list (e-prescription/dispense system)

•does not replace paper prescription yet (just for capturing data)!

Covered use-casesPrescription create / query / cancel / changeDispense create / query / stop intake / change dosage (including OTC)Query Medication List

Community Pharmacy profiles usedWorkflow: CMPDContent: PRE, DIS, PADV, PML

Embedded into national Health Record infrastructure (ELGA)based on IHE XDS

Becoming real – in Saudi Arabia

Saudi e-Health Exchange projectGoals of “Medication track”

• Introducing e-Prescription/Dispense (replacing paper)• Providing a “Medication List” of a patient for physicians and pharmacists• including hospital medications (out of discharge summary)• Provide a central service for “Medication Interaction Checking”• Specification phase now completed

Covered use-casesPrescription create / query / cancel / change / suspendDispense create / query / stop intake / change dosage / suspend (including OTC)Query Medication ListCentral Medication Interaction Checking and Issue Management

Community Pharmacy profiles usedWorkflow: CMPDContent: PRE, DIS, PADV, PML

Embedded into Saudi e-Health Exchange infrastructure (SeHE)

based on IHE XDS

Becoming real – in Switzerland

Swiss e-Medication projectGoal of the project (Geneva driven)

• Increasing patient safety by sharing the “Medication Treatment Plan” of a patient between all stakeholders (hospitals, private physicians, pharmacists, home care, …)

• Defining a national profile for sharing patient’s medication related information in relation with the forthcoming federal law on the electronic patient record (2017)

• Cantonal roll-out – hospital, physicians, pharmacists and home care will be connected to the shared treatment plan module of the regional Health Information Exchange

• Rollout and startup first quarter 2016 on a voluntary basisTo achieve the goal …

• Implementation of IHE content profiles based communication in the regional HIE• Implementation of the management of the CDAs as an OpenSource project (eHealth-Connector) in order to

ease the integration by third party vendors• Wide concertation will all stakeholders in the country in order to promote the national exchange format

Covered use-casesQuery Medication List and Medication list updatePrescription create / query / cancel / changeDispense create / query / stop intake / change dosage (including OTC)Add comments to plan / prescription / dispense (home care)

Community Pharmacy profiles usedContent: MTP, PRE, DIS, PADV, PML

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

Other Pharmacy activities

• IHE started by covering the clinical part of the medication circuit:

From prescription to administration

• Based on the de facto standards: CDA and HL7 v2.

• This clinical part must be interoperable with other parts:

• The distribution / supply of medication across and inside institutions

• The management of medications• Other processes using medication (radiology, surgery)

Supply of Products for Healthcare

• A cross-domain and cross-standard guidance on how to exchange information for the supply of products:

• Order from suppliers, delivery inside an institution, automated dispensing, traceability, barcode-enabled tracking and stock management

• Whitepaper being developed, work on profiles starting as well

• GS1 and HL7 are the enabling standards

Supply – areas covered

Catalog maintenance

Orders and returns

Inventory management

Usage report & tracking

Billing

Selection of vendors | Pricing & Contracts | Update product dataInternal data (Clinical data, internal prices, usage rules, usage

instructions)

Availability and recall

Permissions, availability, recall

Stock orders and bulk orders

Consignment items

Point of care ordering & order processing

Consult product data

Consignment items

Patient charges / intra-hospital charges

Hospital billing

Manufacturer Distributor Hospital

DispensingSystems Point of care

Patient usage

Stock status, consumption

Common Pharmacy Profile• Health IT is moving to support innovation, distributed

applications, mobile computing, web-enabled solutions, ...• This requires faster-to-adopt, faster-working interoperability.• HL7 FHIR is a draft standard that enables it.

• A new set of profiles is being created to advise implementers how to prepare for the new standard:• “The Common Pharmacy Profile”• Includes aspects like workflow management, constraints and

recommendations to support from traditional systems to mobile applications

• We do this by using the best of our existing profiles, our experience and preparing a common profile, ready for the future challenges

“Common” Panorama

Dispensing Administration

Supply

Medication Lists

ADE reporting

Planning

Medication Statements

Medication Catalog

PrescribingReview / Advice

For Communities For HospitalsFHIR-based (common)

ADE = Adverse Drug Event

Other activities

• Medication Catalog / Formulary• How do we identify medication across different systems? Are

names sufficient? Are codes necessary? How do we distribute the medication attributes across several systems?

• Medication Data capture / Medication Documentation• How to retrieve data from prescriptions, dispenses, etc. In

order to create a “medication list”

• Medication Administration (in Community domain)• More and more eligible to document electronically also in

Community domain• Ambulant Chemotherapy, Controlled drug-substitution, ...

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

So, do we need to change our habits?

eHealth is going to play a very important role in our real life in Hospital and Community Pharmacies

Emergence of patient-enabling solutions Increased trend to automate distribution of

medications Traceability becomes important – for clinical

reasons, as well as prevention of falsification

We (pharmacists) have to focus on the:

Clinical Pharmacy Use of medication across settings and domains Oncology Pharmacy Social Pharmacy Pharmacy Informatics …

Patients must be our main concern!

For Pharmacists, IHE Pharmacy, means:

Improved Hospital Pharmacy information through integrated access to medication information

Reduced physicians and nurses callbacks to pharmacists due to lack of medication information

Eliminating pharmacist call backs to physicians and nurses to resolve medications issues

Reduced pharmacists time to process special authority requests and logistics

IHE Pharmacy is the key to help us find solutions!

Learning objectives

• Understand PHARM vision, mission and strategic goals• Understand PHARM domain's liaison and collaboration with HL7 and

ISO• Overview of existing PHARM profiles and Community and Hospital

Pharmacy, including Community Medication Prescription and Dispense, Hospital Medication Workflow, Medication Treatment Plan

• Overview of other PHARM domain activities, including Supply Chain, FHIR

• Understand how PHARM work benefits the pharmacists• How to get involved in PHARM committee work

How to participate in IHE Pharmacy

• 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 http://groups.google.com/group/ihe-pharmacy

Meetings are F2F and TConsJust join in!

Participate IHE’s Profile Cycle

Links

• White Paperftp://ftp.ihe.net/Pharmacy/White%20Paper/

• Technical Frameworkshttp://www.ihe.net/Technical_Framework/index.cfm#pharmacy

• Pharmacy Wikihttp://wiki.ihe.net/index.php?title=Pharmacy

Strategic planning page• http://wiki.ihe.net/index.php?title=PHARM_Strategic_Planning

Roadmap• http://wiki.ihe.net/index.php?title=PHARM_Roadmap

Committees• http://wiki.ihe.net/index.php?title=Pharmacy_Planning_Committee • http://wiki.ihe.net/index.php?title=Pharmacy_Technical_Committee

• Google group• http://groups.google.com/group/ihe-pharmacy

• Changing the Way Healthcare CONNECTS

http://www.ihe.net

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