IBM Drug Information System (DIS) Overview IBM Canada Health Care Team
Pharmaceutical Information Network
Agenda
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Welcome and Introductions
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Drug facts - Medication management business drivers
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IBM’s experience with Canadian drug information systems
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Pharmaceutical Information Network (PIN) functional overview – What is PIN? – Demonstration
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Solution Components – Evolving to a full-function pharmaceutical information management solution
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Lessons learned
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Questions and Discussion (over wine!) Global Business Services
Pharmaceutical Information Network
Background: IBM’s Role in Canadian Drug Information Systems
BC – IBM Integrated, Implemented, Operated and Maintained PharmaNet
AB – IBM Designed, SK – IBM Designed, Customized, Developed, Installed, Implemented and Maintained, Deployed Maintain PIN and Operated PIN
25,000 Users, 100M+ Prescriptions 3
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QC – IBM Selected, Designed and Implementing SQIM
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Drug facts - Medication management business drivers
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In Canada, more money is spent on drugs than on physicians. (Canadian Institute for Health Information, Health Expenditure Trends 1975-2002)
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Drugs account for the second largest category of health expenditures (next to hospital services). (Canadian Institute for Health Information, Drug Expenditures in Canada 1985-2001)
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In 2001, spending on drugs was expected to have reached $15.5 billion, representing 15.2% of total health care spending. (Canadian Institute for Health Information, Drug Expenditure in Canada 1985-2001)
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Two recent Canadian studies on health reform both specified the need for Canada-wide catastrophic drug coverage. (The Health of Canadians – The Federal Role (Kirby Report, September 2001; Building on Values - The Future of Health Care in Canada, Romanow Report, November 2002)
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Background: PIN in Alberta •
IBM designed, developed and deployed Seniors Drug Profile, Pharmaceutical Network and the 1st Alberta Electronic Record
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Facilitated extensive clinician engagement as part of the PIN design and implementation
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Developed support infrastructure for EMR/EPR vendor messaging implementation
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IBM has provided Transition and Change Management support and deployed all of these applications, to health care providers throughout Alberta, since 1999
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IBM is currently contracted by AH&W to deploy Alberta NetCare (AB EHR) – Includes EMR system messaging and Pharmacy system batch upload
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Pharmaceutical Information Network (PIN) Functional Overview
Pharmaceutical Information Network
PIN Overview – Solution evolution 1999
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2001
2002
2003
2004
2005
2006
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PIN Version 3
PIN Version 2 • • • •
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PIN Version 1 Created by IBM and Alberta Health and Wellness Medication Profile Viewer and Electronic Prescribing Deployed to practitioners throughout Alberta Version 1 medication profile viewer deployed in Saskatchewan Global Business Services
• Technology Refresh and Performance Testing • Deployed to Alberta • Version 2 ePrescribing deployed to Saskatchewan practitioners
• Addition of Pan-Canadian standard HL7 V3 (CeRx) compliant messaging • Update of Graphical User Interface • Completion scheduled for March 31, 2008
2008
Pharmaceutical Information Network
PIN Overview: What is PIN? •
A solution that: – Links community physicians, pharmacists, hospitals and other authorized health care providers by providing them confidential shared access to patients’ active medication profiles – Provides online decision-support tools for prescribing, dispensing, compliance monitoring, research and policy development – Existing EMR or EPR CPOE functions ‘build the script' and then communicate with PIN for interaction checking and to create the electronic prescription – Pharmacy systems also communicate with PIN to conduct interaction checking at dispense time – These prescribing and dispensing records are stored in PIN’s database for access by other providers
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PIN Overview: How is PIN delivered? •
Conceptually simple: – Central clinical data repository for each jurisdiction – No duplicate data entry – Links existing heterogeneous systems
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Other Points of Care
Two access methods: – From EMRs/EPRs and Pharmacy Systems through system-to-system messaging that is transparent to users – Through a Web browser where systemto-system capability is not available or not required
Central Clinical Data Repository Pharmacies
Physician Offices and Clinics
Hospital
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Pharmaceutical Information Network
How does PIN work in a physician’s office? Receptionist Printed Prescription EMR
EMR
History
Patient EMR
Physician, at point of care
Nurse EMR
System-to-System Interface
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Patient takes printed EMR prescription to pharmacy
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PIN Database
In Alberta, PIN is currently supporting EMR system messaging with 10 EMR system vendors: • • • • • • • • • •
Clinicare EMIS Jonoke Med-Access Microquest Nightingale Optimed Practice Solutions Telin Wolf
Pharmaceutical Information Network
PIN Overview: Functionality Summary PIN Web GUI Create and Manage Prescriptions – Hold, Release, Renew, Discontinue, etc.
Messaging Create and Manage Prescriptions – Hold, Release, Renew, Discontinue, etc.
Create and Manage Allergies / Intolerances
Create and Manage Allergies / Intolerances
Contraindication / Dosage Management
Contraindication / Dosage Management
– Drug to Drug, Drug to Allergy, Over/Under dose
– Drug to Drug, Drug to Allergy, Over/Under dose
Masking
Masking
Drug Monograph
Drug Monograph
Patient List Reports and Reference Links – Access Report, Medication Reconciliation Report
Create and Manage Device Prescriptions Record Patient Observations Record Patient Notes
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PIN Overview: Benefits of PIN
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Accurate and complete patient medication profile – Data from from multiple sources and multiple health service providers can be viewed by any authorized user – Active medication profile (prospective view of treatment intent)
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Legible prescriptions – Reduced transcription errors – Reduced phone calls between pharmacies and physicians – Can be understood by the patient
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Decision support tools – – – – –
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Warnings for drug-drug interactions and drug-allergy interactions Dosage checking Duplicate therapy Online reference tools PIN also provides a foundation for other drug utilization review requirements
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PIN Overview: PIN V1 to PIN V2 - Technology Upgrade and Performance Testing Objective
Technology Upgrade Results
Scalability
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Availability Performance Portability
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Vitality
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Both vertical and horizontal scalability of the PIN application and database have been proven Very high transaction volumes achieved PIN positioned for failover and high availability GUI response times met all Alberta targets PIN is now operating system independent and is currently running on both Windows and Unix platforms Database conversion effort has been greatly reduced due to use of Hibernate objects PIN aligned with CHI reference model through externalization of Person, Facility, Provider and Security interfaces Custom components updated to commonly used components. The utilization of commonly used open source components
Extensive performance and scalability testing was executed throughout the PIN V2 development effort, resulting in the system meeting all response time and transaction volume targets
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PIN Overview: PIN V2 to PIN V3 - CeRx Messaging Support
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In November 2006, Saskatchewan Health and IBM, with funding from Canada Health Infoway, launched the PIP Phase 2.4 – CeRx project Enhanced PIN to support CeRx messaging Results - 52 messages supported, GUI updated to use new, CeRxcompliant data model Availability – 1st Quarter 2008 PIN V3 - CeRx highlights – The solution supports V01R04.3 of the CeRx specification (Sept 11, 2006 “Stable for Use” version plus all Urgent Release updates) – The IBM project team worked closely with Canada Health Infoway throughout the project and requested/recommended a number of specification changes – Infoway has reviewed and approved the project’s CeRx requirements documentation
The project is currently in User Acceptance Testing with Saskatchewan Health. Final performance testing is in progress 14
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PIN Deployment in Saskatchewan
Pharmaceutical Information Network
The Saskatchewan Pharmacy Information Program (PIP) vision is to provide end-to-end support for the prescribing, dispensing, and claims adjudication processes
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Clinician Reviews Patient Chart
Clinician
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Review Medication Profile
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Identify Problem
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Review Reference Material / Clinical Guidelines
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Review Treatment Alternatives / Best Choice Guidelines
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Generate Prescription Using Clinical Tools
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Record, Print And Sign Prescription
11 Review Medication Profile
Pharmacist 12 Retrieves (or enters) Prescription
Pharmacy Pharmacy Information Information Program Program
13 Review Prescription and Reference Material Review Prescription 14 Using Clinical Tools 15 Submit Drug Claim for Adjudication
Pharmacist
16 Record Dispensed Medication 1
Patient Presents At Clinician Office 9
Provide Patient with Prescription
Fill 17 Prescription and Dispense Medication Patient Presents at 10 Pharmacy with Prescription
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Pharmaceutical Information Network
Progress towards this vision began with the ‘All Drugs for All People’ (ADAPT) project’s extension of current business practice to include all dispensed medications Pharmacy Pharmacy Information Information Program Program Adjudication Adjudication ClaimsHistory History Claims (fromADAPT) ADAPT) (from
ADAPT function 11 Review Medication Profile
PIN function
Pharmacist 12 Retrieves (or enters) Prescription
Complete Complete Dispensing Dispensing Record Record
15 Submit Drug Claim for Adjudication
Pharmacist
16 Record Dispensed Medication Fill 17 Prescription and Dispense Medication Patient Presents at 10 Pharmacy with Prescription
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Pharmaceutical Information Network
Building on ADAPT, the initial phase of Saskatchewan’s program provided a medication profile viewer for clinicians
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Review Medication Profile
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Identify Problem
Clinician Reviews Patient Chart
Pharmacy Pharmacy Information Information Program Program Adjudication Adjudication ClaimsHistory History Claims (fromADAPT) ADAPT) (from
ADAPT function 11 Review Medication Profile
PIN function
Pharmacist 12 Retrieves (or enters) Prescription
Complete Complete Dispensing Dispensing Record Record Medication Medication Profile Viewer Profile Viewer Clinician
15 Submit Drug Claim for Adjudication
Pharmacist
16 Record Dispensed Medication 1
Patient Presents At Clinician Office
Fill 17 Prescription and Dispense Medication Patient Presents at 10 Pharmacy with Prescription
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Pharmaceutical Information Network
Recent phases have introduced PIN’s prescribing support and decision support tools that subsequent phases will extend to pharmacists through functions supported by the CeRx message specification
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Clinician Reviews Patient Chart
Clinician
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Review Medication Profile
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Identify Problem
Pharmacy Pharmacy Information Information Program Program
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Review Reference Material / Clinical Guidelines
Adjudication Adjudication ClaimsHistory History Claims (fromADAPT) ADAPT) (from
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Review Treatment Alternatives / Best Choice Guidelines
Complete Complete Dispensing Dispensing Record Record
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Generate Prescription Using Clinical Tools
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Record, Print And Sign Prescription
Patient Presents At Clinician Office
Medication Medication Profile Viewer Profile Viewer Clinical Clinical Decision Decision SupportTools Tools Support Complete Complete Prescribing Prescribing Record Record
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Provide Patient with Prescription
ADAPT function 11 Review Medication Profile
PIN function
Pharmacist 12 Retrieves (or enters) Prescription 13 Review Prescription and Reference Material Review Prescription 14 Using Clinical Tools 15 Submit Drug Claim for Adjudication
Pharmacist
16 Record Dispensed Medication Fill 17 Prescription and Dispense Medication Patient Presents at 10 Pharmacy with Prescription
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As it evolves, Saskatchewan’s Pharmaceutical Information Program provides an increasingly rich source of information for research, planning, and program management processes
Information Information Warehouse Warehouse • Quality Council • Academic, Research, and Professional Analysis • Health System Analysts and Planners
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• Query • Reporting • Analysis
Information Types • Prescribing • Dispensing • Allergies • Alerts • Audit • Others
Pharmacy Pharmacy Information Information Program Program Adjudication Adjudication ClaimsHistory History Claims (fromADAPT) ADAPT) (from Complete Complete Dispensing Dispensing Record Record Medication Medication Profile Viewer Profile Viewer Clinical Clinical Decision Decision SupportTools Tools Support Complete Complete Prescribing Prescribing Record Record
Pharmaceutical Information Network
PIN Demonstration
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Patient Lookup
Various search options are provided.
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Patient Medication Profile
3. The New Rx button is selected to begin a new prescription
2. Details of each prescription are provided by selecting the associated link
1. The left-hand screen shows the patient’s current profile, the right hand shows the dispense history
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Create a Short-term Prescription
The patient has presented with strep throat and will receive a short term prescription for Biaxin.
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Create a Short-term Prescription
The physician can search for the formulation desired, and can also use favorites
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Pharmaceutical Information Network
Create a Short-term Prescription
Review Rx is then selected If a favorite isn’t used, the relevant prescribing information is filled in
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Create a Short-term Prescription
2. Once the pharmacist has entered the prescription through their pharmacy system, this status will be change to “filled”
1. The resulting prescription is then shown and can be printed and provided to the patient. Multiple prescriptions can be created before saving and printing
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Multiple Drug Renew
1. The patient will be away for an extended period and requires all continuous prescriptions to be renewed.
2. The physician can choose the Multiple Rx Options button to perform activities on multiple prescriptions at a time.
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Multiple Drug Renew
The physician selects the drugs to renew and then selects the Renew button
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Pharmaceutical Information Network
Multiple Drug Renew
The physician enters the desired therapy end date or duration of therapy, and all selected drugs are renewed appropriately
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Multiple Drug Renew
The renewed prescriptions are now ready to save and print
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Support for Allergy Information
PIN can capture allergy information for a patient, and use it to warn physicians of potential allergy to drug interactions
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Pharmaceutical Information Network
Dispense Screen
Based on user feedback, PIN V3 has been enhanced to include a dispense view and report
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Pharmaceutical Information Network
Favorites
To facilitate the prescribing process, practitioners can save “favorites” that can be selected and pre-populate the fields during PIN’s prescribing functions
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Pharmaceutical Information Network
User Preferences
The receipt of warnings and the requirement to manage drug interactions and overdose situations can be customized on a per-user basis
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Pharmaceutical Information Network
Medication Reconciliation Form
A very successful addition to PIN’s functionality has been the Medication Reconciliation Form which is being used by hospitals in Saskatchewan to provide preadmission drug information
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Pharmaceutical Information Management Solution Components
Pharmaceutical Information Network
Pharmaceutical Information Management solution components Provider and Provider and Patient Access Patient Access
Clinical Pharmaceutical Information Management Clinical Pharmaceutical Information Management
2 Pharmacy Office System
Provider Provider and and Patient Patient Portal Portal
Physician Office System
5 Clinical Viewer
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2
Prescribing Functions
Knowledge and CDS Tools
Dispensing Functions
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Prescribing Messages Dispensing Messages
System – System to – – to – System System Access Access
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Integration Broker and Message Switch (EHR)
Clinical Pharmaceutical Information System
4 Claims Message
Registries (EHR)
Secure Secure Network Network
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6 Patient Access
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2
5
2
Hospital Information System
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Standards
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Active Medication Profile
Public and Private Claims Adjudication and Administration
Dispensing and Claims Information
Pharmaceutical Information Network
PIN as an Infoway Drug Information System (DIS) e-Health e-HealthShared SharedServices Services Jurisdiction Jurisdiction
EHR Data and Services Public Health Comm. Disease Surveillance
Enterprise RIS / PACS
Drug Information System
Enterprise Shared Health Record
EHR Integration Services Provider Registry
EHR Index
Integration Broker
Security Management
Client Registry
Privacy Management
EHR Portal
ADT
Clinical Information System
Insured Clients Registry
Physician Office System
Pharmacy System
Prescription Drug Program
Regional Health Regional Health Authorities Authorities Point of Service Point of Service 39
Ministry of Health Ministry of Health
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Physician Office Physician Office Comm. Health Comm. Health Centres (CHCs) Centres (CHCs) Point of Service Point of Service
Registration System
Pharmacy Pharmacy Point of Service Point of Service
Professional Professional Association Association
Pharmaceutical Information Network
PIN as an Infoway Drug Information System (DIS) e-Health e-HealthShared SharedServices Services Jurisdiction Jurisdiction A jurisdiction’s Client and Provider Registry data is accessed through PIN’s external interface
EHR Data and Services Public Health Comm. Disease Surveillance
Enterprise RIS / PACS
Drug Information System
PIN will use the security and privacy services provided by Ontario’s EHR
Enterprise Shared Health Record
EHR Integration Services Provider Registry
EHR Index
Client Registry
Integration Broker
Security Management
PIN can also integrate with an Ontario Provider and Client Portal
Privacy Management
PIN is currently available to Alberta NetCare users through the Orion portal
EHR Portal
ADT
Clinical Information System
Insured Clients Registry
Physician Office System
Pharmacy System
Physician and Pharmacy office systems will interact with PIN via CeRx HL7 V3 messages an HL7 V3 system to access and populate its Drug Repository
Prescription Drug Program
Regional Health Regional Health Authorities Authorities Point of Service Point of Service 40
Ministry of Health Ministry of Health
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Physician Office Physician Office Comm. Health Comm. Health Centres (CHCs) Centres (CHCs) Point of Service Point of Service
Registration System
Pharmacy Pharmacy Point of Service Point of Service
Professional Professional Association Association
Pharmaceutical Information Network
Lessons Learned • Stakeholder engagement at both advisory and working group-levels provides valuable guidance in release and change management planning – Physicians, pharmacists, and other providers and their respective professional associations – Claims administration and health sector clinical information management representatives
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Early availability of clinically relevant medication information is invaluable to jump start adoption – All Drugs, All People – Community dispensed medications initially, followed by inpatient medications
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Pharmaceutical information is core data for many clinical health information initiatives; the pharmaceutical information program must align with other Ontario health sector initiatives – Primary Care Teams, Community Health Centres, Chronic Disease Prevention and Management
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Implement the full-function pharmaceutical information solution through a series of complementary projects – Ensure each project provides stakeholder business value
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Develop a strong change management program to encourage early adoption and sustain use – Communication planning and materials, implementation planning and installation services, training materials and support, post-implementation evaluation and issue resolution
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PIN Value Summary •
Provides functions and information that address key business drivers – Improve patient care and quality and provide clinicians with information to support appropriate drug therapy
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Integrate with provincial investments and provide an Infoway-compliant Drug Information System (DIS) – Can be implemented as a standalone system or as an Infoway-compliant EHR Data and Service Drug Information System (DIS) provider
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Support ePrescribing through both Web GUI and Infoway-compliant CeRx HL7 V3 message interfaces
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Proven solution backed by IBM experience and integration capability – First installed in 2002, two versions since then have modernized the solution and expanded its function – Production installations in both Alberta and Saskatchewan
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Questions?
Supporting Material
Pharmaceutical Information Network
Phase 1 - CeRx Messages – 33 of 52
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Prescribing
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Dispensing
– Create New Prescription – Clinical Pre-Determination – Stop Prescription – Hold Prescription – Release Prescription – Revoke Dispensing Permission – Record Non-Prescribed Drug – Update Non-Prescribed Drug
– Fill Prescription – Transfer Prescription – Prescription Pickup – Abort Fill – Record non-Fill of Prescription
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Consent
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Common Functions
– Mask Clinical Data – Unmask Clinical Data – Record Consent
– Retract Request – Add Record Note
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Patient Queries
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Allergies/Intolerances
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Drug Queries
– Get Dispenses for a Drug Prescription – Get Single Drug Dispense Details – Get Patient Medication Details – Get Patient Medication Summary – Get Patient Other Medication Details – Get Medication Profile Generic Query – Get Patient Drug Contraindications
– Add Allergy, Intolerance – Update Allergy, Intolerance – Get Patient Allergies, Intolerances – Get Allergy, Intolerance Change History – Get Drug Documentation Information – Search Drug Products – Query Drug Detail – Contraindication Checking Against a Full Set of Drugs
Pharmaceutical Information Network
Phase 2 - CeRx Messages – 19 of 52 •
Patient Queries – Get Patient Drug Dispense History – Get Patient Prescriptions, Never Dispensed – Get Patient Prescriptions with Remaining Dispenses – Get Patient Drug Prescription Order Summary – Get Prescription Drug Order with No Dispenses – Get Drug Prescription Event History
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Device Prescribing/Dispensing – Create Device Prescription – Fill Device Prescription – Get Dispenses for a Device Prescription – Get Patient Device Dispense History – Get Single Device Dispense Details – Get Patient Device Prescription Order Summary – Get Prescription Device Order with No Dispenses – Get Device Prescription Event History
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Patient Observations – Record Basic Patient Observations – Review Basic Patient Observations
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Patient Notes – Add Patient Note – Remove Patient Note – Query Patient Notes
Pharmaceutical Information Management Solution Transition States
Pharmaceutical Information Network
Current state - Starting point Pharmacy Pharmacy Connectivity Connectivity
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Pharmacy Office System Claims Message
System – System to – – to – System System Access Access
Secure Secure Network Network
Public and Private Claims Adjudication and Administration
Dispensing and Claims Information Comprehensive record of dispensed medications?
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Pharmaceutical Information Network
Transition state 1 – Medication Profile – Alternative 1 – Existing Claims Administration System Pharmacy Pharmacy Connectivity Connectivity and Provider and Provider Access Access
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Pharmacy Office System
System – System to – – to – System System Access Access
Web Browser
Drug Profile Viewer
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Secure Secure Network Network
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Claims Message
Public and Private Claims Adjudication and Administration
Dispensing and Claims Information Comprehensive record of dispensed medications
Pharmaceutical Information Network
Transition state 1 – Medication Profile – Clinical Pharmaceutical Information System Provider Provider Connectivity Connectivity and Access and Access
Clinical Pharmaceutical Information Management Clinical Pharmaceutical Information Management Medication Profile Functions
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Knowledge Tools
Pharmacy Office System
System – System to – – to – System System Access Access
Hospital Information System
Secure Secure Network Network
Clinical Pharmaceutical Information System
Medication Profile Comprehensive dispensed medications record
Integration Broker and Message Switch
Medication Profile Message
Claims Message
Registries (EHR)
Clinical Viewer - Drug
Chronic Disease Information System Chronic Disease Prevention and Management Chronic Disease Prevention and Management 50
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Public and Private Claims Adjudication and Administration
Dispensing and Claims Information
Pharmaceutical Information Network
Transition state 2 – Prescribing support Provider and Provider and Patient Access Patient Access
Clinical Pharmaceutical Information Management Clinical Pharmaceutical Information Management
Prescribing Functions
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Knowledge and CDS Tools
Pharmacy Office System
Provider Provider Portal -1 Portal - 1 Physician Office System
Prescribing Messages Dispensing Messages
System – System to – – to – System System Access Access
Integration Broker and Message Switch (EHR)
Clinical Pharmaceutical Information System
Comprehensive dispensed medications record Claims Message
Hospital Information System
Secure Secure Network Network
Registries (EHR)
Clinical Viewer - Drug
Standards - 1
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Active Medication Profile
Public and Private Claims Adjudication and Administration
Dispensing and Claims Information
Pharmaceutical Information Network
Transition state 3 – Dispensing support (full ePrescribing) and patient access Provider and Provider and Patient Access Patient Access
Clinical Pharmaceutical Information Management Clinical Pharmaceutical Information Management
Prescribing Functions Pharmacy Office System
Provider Provider and and Patient Patient Portal - 2 Portal - 2
Physician Office System
Prescribing Messages Dispensing Messages
System – System to – – to – System System Access Access
Hospital Information System
Clinical Viewer - Drug
Secure Secure Network Network
Patient Access
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Integration Broker and Message Switch (EHR)
Knowledge and CDS Tools
Clinical Pharmaceutical Information System
Registries (EHR)
Standards - 1
Global Business Services
Dispensing Functions
Active Medication Profile Comprehensive dispensed medications record
Claims Message
Pharmaceutical Pharmaceutical Claims Claims Administration Administration
Public and Private Claims Adjudication and Administration
Dispensing and Claims Information
