IHE Pharmacy Domain Update

Webinar
Jrgen Brandsttter, MSc
Co-chair Pharmacy Planning committee
Co-chair Global Deployment Coordination Committee (GDC)
IHE International Board
CodeWerk Software GmbH, Austria

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

Standards
IETF
Use cases typically require
combinations of standards
- but how to compose?

IHTSDO

What is IHE?
Standards
IETF

IHTSDO

Profiling and Testing

eHealth Projects

IHE methodology
Projects
Products

Identify
available
standards

Products
declare
IHE

Use Case

Easy to integrate products

RFPs
with IHE
reqs

IHE: Difference to classic SDO

Classic Standards Developing Organization
Develops future standards in certain areas

IHE
Uses 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

Pharmacy
since 2008

IHE Dental

Radiology
since 1998
Cardiology
since 2003

IHE Endoscopy

Pathology
since 2006

Eye Care
since 2006

Laboratory
since 2003
(Healthcare)
IT Infrastructure
since 2003

Quality
Research & Public Health
since 2007

since 2008
Patient Care Devices
since 2005

Radiation Oncology
since 2004

Patient Care Coordination

since 2005

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, Rseau 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
Big success: European Commission recognizes
HL7 Pharmacy
27 IHE profiles that should be referenced in
ISO TC215 WG6 Pharmacy
public procurement documents1)
NCPDP
-> 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 251

Global recognition

IHE Pharmacy
Profiling Layer

Friendly
collaboration

HL7 Pharmacy
Base Standards

Liaisons

ISO TC 215 WG6 / CEN

ISO Standards

Global recognition

IHE Pharmacy
Profiling Layer

Contributions

HL7 Pharmacy
Base Standards

Base and
legal binding
standards

Liaisons

High-level

Projects

ISO Standards

ISO TC215 WG6 / CEN

Global recognition

IHE Pharmacy
Profiling Layer
Technical

Profiles
(Use Cases)

HL7 Pharmacy
Base 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

Validation of the prescription
(ICA check, etc.)

Prescription

Prescribed

Specialist, GP

Rejected

Clinical result of medication

Pharmaceutical
advice
Pharmacist

Approved

Dispense
Pharmacist

Repeat
dispense

Administration
Patient, Nurse, Family member

Dispensed

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 Dispense
Medicinal 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

Create
Prescription

Create Dispense

Create Prescriptions/Dispenses

Create
Prescription

Medication Interaction Checking

Create Dispense

Manage Prescriptions/Dispenses
Manage Prescriptions/Dispensations

Manage Prescriptions/Dispenses
Manage Prescriptions/Dispensations

Medication Interaction Checking

Query/Retrieve Medication
Documents

The way of a prescription

PRE

PI 1

Physician prescribes
a prescription with 5
prescription items

PI 2
PI 3
PI 4
PI 5

The way of a prescription

Physician cancels PI 3

Physician changes PI 1

PRE

PI 1

PADV

PADV 1

PADV

PI 2
PI 3
PI 4
PI 5

PADV 3

The way of a prescription

Pharmacist dispenses
all PIs

PRE

PI 1

PADV

PADV 1

DIS

DIS 1

DIS 2

PI 2
PI 3
PI 4
PI 5

DIS

DIS

DIS 4

DIS

DIS 5

The way of a prescription

Physician changes dosage

of DIS 2
and instructs the patient to
stop intake of DIS 5

PRE

PI 1

PADV

PADV 1

DIS

DIS 1

DIS 2

PI 2
PI 3
PI 4
PI 5

DIS

PADV

PADV 2

DIS

DIS 4

DIS

DIS 5

PADV

PADV 5

Planning / Actual

Physician
starts
medication
treatment

Physician
changes
dosage

PADV

PADV
Change

MTP

PRE

Physician
changes
dosage
again

Patient
runs out of
medication
s

DIS

DIS

PADV
Change

Change

PRE

DIS

Action

Plan

Actual
Time

Logical flow

Leads to

Reference to MTP

Reference to PRE

Reference to DIS

Becoming real in epSOS

European Patient Smart Open Services
Goals (relevant for IHE Pharmacy)
Cross-border prescription and dispense
Demonstrated in pilot use
Covered use-cases
Prescription query (cross-border)
Dispense create (cross-border)

Community Pharmacy profiles used

Content: PRE, DIS

Synced

1) Concept derived from epSOS

2) Worked in sync with epSOS
3) Further elaborated in IHE

Becoming real in Austria

Austrian e-Medication project
Goal 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-cases

Prescription create / query / cancel / change

Dispense create / query / stop intake / change dosage (including OTC)
Query Medication List

Community Pharmacy profiles used

Workflow: CMPD
Content: PRE, DIS, PADV, PML

Embedded into national Health Record

infrastructure (ELGA)
based on IHE XDS

Becoming real in Saudi Arabia

Saudi e-Health Exchange project

Goals 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-cases

Prescription create / query / cancel / change / suspend

Dispense create / query / stop intake / change dosage / suspend (including OTC)
Query Medication List
Central Medication Interaction Checking and Issue Management

Community Pharmacy profiles used

Workflow: CMPD
Content: PRE, DIS, PADV, PML

Embedded into Saudi e-Health

Exchange infrastructure (SeHE)
based on IHE XDS

Becoming real in Switzerland

Swiss e-Medication project

Goal 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 patients 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 basis

To 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-cases

Query Medication List and Medication list update

Prescription create / query / cancel / change
Dispense create / query / stop intake / change dosage (including OTC)
Add comments to plan / prescription / dispense (home care)

Community Pharmacy profiles used

Content: 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

Manufacturer

Distributor

Dispensing
Systems

Hospital

Point of care

Catalog maintenance
Selection of vendors | Pricing & Contracts | Update product data
Internal data (Clinical data, internal prices, usage rules, usage
instructions)
Consult product data

Inventory management
Availability and recall
Permissions, availability, recall

Orders and returns

Stock orders and bulk orders
Point of care ordering & order processing
Consignment items

Usage report & tracking

Consignment items
Patient usage
Stock status, consumption

Billing
Patient charges / intra-hospital charges
Hospital billing

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

Medication
Catalog

Medication
Statements

Medication
Lists

Planning

Prescribing

Review /
Advice

Dispensing

Administration

ADE
reporting

ADE = Adverse Drug Event

Supply

For Communities
For Hospitals
FHIR-based (common)

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

Participate IHEs Profile Cycle
Committee work follows the IHE Profile Cycle
Annual cycle

Sep
Dec
Jun
Jul

Dec:
Jun:
Jul:
Aug:

Call for proposals

Working on work-items
Public comment
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 TCons

Just join in!

Links
White Paper
ftp://ftp.ihe.net/Pharmacy/White%20Paper/

Technical Frameworks
http://www.ihe.net/Technical_Framework/index.cfm#pharmacy

Pharmacy Wiki
http://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

Our new mortar is digital