Your SlideShare is downloading. ×
0
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Kanaka Ramyasiri   interoperability and e medicines management within the hospital setting
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Kanaka Ramyasiri interoperability and e medicines management within the hospital setting

228

Published on

Kanaka Ramyasiri delivered the presentation at the 2013 eHealth Interoperability Conference. …

Kanaka Ramyasiri delivered the presentation at the 2013 eHealth Interoperability Conference.

The 2013 eHealth Interoperability Conference program is a balance between updates on state-wide interoperability projects, health service eHealth project case studies, and discussions of overarching principles such as information governance, data standardisation, and the future direction of eHealth in Australasia.

For more information about the event, please visit: http://www.informa.com.au/eHealth13

Published in: Technology, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
228
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Interoperability and eMedicines Management within the Hospital Setting Dr Kanaka Ramyasiri Clinical Architect HealthShare Ltd Midland District Health Boards NZ Hospital eMedicines Programme
  • 2. Interoperability and eMedicines Management • A walk through of a piloted intra-hospital eMedicines Landscape • Benefits arising from intrahospital electronic sharing of patient medicines information • Standards utilised to share medication details
  • 3. But more importantly! • Lets deconstruct our pilot implementation to expose Wider Lessons & Observations related to interoperability in general Zen and the art of interoperability…
  • 4. Where are we?
  • 5. Where are we?
  • 6. Taranaki
  • 7. Programme Context • This pilot solution is affiliated to and part funded by the New Zealand Hospital eMedicines Programme and the New Zealand Medication Safety Programme in conjunction with Taranaki District Health Board. • This solution in conjunction with 2 other pilot sites in New Zealand is intended to generate knowledge and learnings to enable widespread rollout of Hospital eMedications Management in the NZ Health Sector.
  • 8. HIMSS definition of Interoperability “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the health status of, and the effective delivery of healthcare for, individuals and communities.” http://www.himss.org/library/interoperability-standards/what-is?navItemNumber=17333
  • 9. New Zealand Strategic Direction • Interoperability is a strategic enabler within the NZ Health IS Plan. • Emphasis on best of breed interoperable systems with national standards for interoperability. • HL7 CDA R2, IHE XDS, SNOMED CT formally endorsed standards in NZ context.
  • 10. NZ Pilot Hospital eMedicines Management Solution Function Application Component Inpatient ePrescribing CSC MedChart Inpatient Dispensing CSC ePharmacy Inpatient eAdministration CSC MedChart Inpatient Electronic Drug Cabinets Carefusion Pyxis eMedicines Reconciliation Orion SMT eDischarge Summary Orion SMT Single Source Allergy Management CSC MedChart Clinical Portal Orion Clinical Portal (aka Concerto) Patient Administration System CSC webPAS Middleware Orion Rhapsody
  • 11. Integration Schematic
  • 12. But what is the diagram not telling us? • How deeply each component talks to each other. • The workflow capabilities in each component that facilitate interoperability • Lets examine some of the key interoperability scenarios contained within the solution and some related general lessons learned
  • 13. High Level Workflow – Within the Hospital • Prescriber Charts Medication on MedChart ePrescribing System Prescribe • Pharmacist Processes prescribed order on ePharmacy Dispensary system • Confirms Product to Dispense or activate on Pyxis Dispense • Nurse can retrieve medication on ward via Pyxis electronic drug cabinet • Records administration in MedChart Administer
  • 14. Ward Prescribing to Dispensary Interoperability • Prescribing actions are messaged to the Pharmacy Dispensary system automatically (ePharmacy). • Workflow capability within ePharmacy enables the management of the incoming Prescription – either dispense the medication, or activate on Pyxis. MedChart Medication Order Message ePharmacy Dispense, or Message to Pyxis
  • 15. What is Pyxis?
  • 16. Ward Prescribing to Dispensary Interoperability Sounds simple, so where are the challenges?
  • 17. Ward Prescribing to Dispensary Interoperability Lesson 1 – Common Code Set / Terminology • We were lucky to have the same vendor supplying both the Prescribing and Dispensary systems which utilised a common medication code set. But we cannot always count on this scenario. • Consistent Medication terminologies still evolving or being implemented. • Compounded, non formulary, or otherwise non- standard medications need to match across both systems.
  • 18. Ward Prescribing to Dispensary Interoperability Lesson 2 – Differing requirements across Professional boundaries need to be managed. • Doctors and Pharmacists view a prescription at different levels. • Not so much of an issue when a trained pharmacist is involved in dispensing a Doctors prescription, but when we are trying to create an electronic workflow… • Doctors deal in generics, or brand names, but rarely specify a strength. • Pharmacists deal in specific strengths and forms of medications.
  • 19. Ward Prescribing to Dispensary Interoperability Doctors Prescription: • “Paracetamol, 1g, four times daily, as needed” Pharmacist Dispensing: • “Panadol 500mg tablets, 2 tablets, four times daily, as needed” Solution – a workflow and business rules within the dispensing system to map a Doctors medication order into an actual Dispensing. • Some human interaction required for the matching process if there are multiple possible dispensing possibilities for a given Prescription.
  • 20. Ward Prescribing to Dispensary Interoperability Lesson 3 – Additional Contextual Information that isn’t immediately apparent may be required to complete or exploit an integration. • Informing the Pharmacy regarding the Priority of a given order – e.g. workflow to indicate item that requires urgent dispensing. • Informing the ward of what stock actually exists on their shelves currently – e.g. display of pharmacy dispensary inventory information via the prescribing system.
  • 21. Ward Prescribing to Dispensary Interoperability Lesson 4 - Further business rules and automation need to be built into the interface. • Automatically process data in a receiving system rather than just present to user. • If full automation not possible, at least attempt to usefully constrain the options presented to a user – e.g. filter a list of options etc. Make the UI useful.
  • 22. eMedicines Reconciliation to Primary Care Discharge • The final Medicines reconciliation report is sent to the Primary Care Physician at the point of discharge electronically, within a greater discharge summary message. • External messaging broker utilised (HealthLink) to store and forward message to Primary Care IS. • HL7 2.x Referral Message used, but with base64 PDF embedded to give greater pagination. • Obviously a candidate for a CDA document and this is in progress at the national level.
  • 23. Old Discharge Summary to Primary Care
  • 24. eMedicines Reconciliation to Primary Care
  • 25. eMedicines Reconciliation to Primary Care Lesson 5 – Progressive Interoperability will get you there • Method of interfacing is “shock horror,” a PDF. • No coded machine interpretable data for the Primary Care physician apart from the patient identifier. • But, very positive feedback from Primary Care. • CDA with structured medications section on the way
  • 26. Allergy Data Interoperability • Key feature of the solution is the creation of a single source of truth for patient allergy and adverse drug reaction data. • Crucial that a patients allergy status is clearly known.
  • 27. Allergy Data Interoperability NHI Medical Warning System PAS SMT Discharge Summary & eMR MedChart Prescribing Decision Support ePharmacy Dispensing Decision Support MedChart Allergies Service Concerto Portal Patient Summary
  • 28. Allergy Data Interoperability – Source Entry
  • 29. Allergy Data Interoperability – ePrescribing View
  • 30. Allergy Data Interoperability – Dispensing / ePharmacy
  • 31. Allergy Data Interoperability – Portal Patient Summary
  • 32. Allergy Data Interoperability – eMedicines Rec
  • 33. Allergy Data Interoperability
  • 34. Key Standards utilised (or to be utilised) HL7 2.x Medication Order Messaging HL7 2.x Referral Messaging NZULM (New Zealand Universal List of Medicines) and NZMT (New Zealand Medicines Terminology) Web Services transport
  • 35. Observations about medication interoperability • Interoperability isn’t a technical exercise. Its primarily a professional and cultural exercise. • Organisational issues regarding professional disciplines and identities abound and are amplified when different departments are brought together via newly interoperable systems.
  • 36. Observations about medication interoperability • Do not maintain a view that “we are just here to provide some technology and the clinical change manager will do the rest” - we are all doomed to failure and frustration with that approach. • Expect that workflow requirements may not have been fully appreciated yet, in spite of prior analysis. • Employ genuine subject matter expertise and strong Clinical Leadership asap in conjunction with technical work…
  • 37. Observations about medication interoperability • Consuming external data is likely to involve a whole new set of electronic workflows within the consuming system. • It is easy to not appreciate the importance of data context when importing from one system to another. • Don’t structure everything for the sake of it. Think of the envisioned follow on workflow / task or report that would utilise that structured element.
  • 38. Kanaka’s Wishlist • All application components expose their key datasets via standards based interfaces, out of the box. • Key application functions are exposed via APIs to allow more than just “document transfer” interoperability. • Local “connectathon” events or labs to accelerate progression of interoperability. Don’t leave it up to implementation projects.
  • 39. Thank you for your attention kanaka.ramyasiri@healthshare.co.nz +64 21 368 047

×