Medication Profile

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Medication Profile Under SVN

SVN Location is under http://gforge.hl7.org/svn/pharmacysig/pharmacysig/Documents/Whitepapers

Definition

• Existing Pharmacy materials – medication order, medication dispense, medication administration, medication statement may be used in a medication profile
• Medication Profiles are essentially queries for some combination of data from the above items that can be persisted for future queries or may be dynamically generated with each query
• May not always be persistent
• Prescriptions – all orders in any state – active, stopped, cancelled, held, etc
• Dispenses – picked up-returned to stock
• Administered
• Medication Statements
• “Current” vs “Active” vs “Past”
• We need definitions for a number of items
• Stephen Chu proposed the following items: medication list, medication profile, medication review, medication reconcilation, medication management plan
• Medication Reconcilation – may be a process – uses medication profiles to “review” and perform reconciliation
• Medication Review is different than Reconciliation – done prior to reconciliation
• It is clear that some people think of a Medication Profile from what content is displayed to a user in an application. This ‘display” may include all of the medication orders, dispenses, statements and events, BUT may also include information such as patient demographics, relevant lab observations, relevant observations (weight, height, BSA/BMI, allergy/intolerances, etc).
• “Treatment type” and other types of data as a means of organizing profile was discussed
• in the Canadian examples, organize into: continuous, short term, external information (i.e. medication statements)
• The focus of the Pharmacy Work Group is on Medication Orders, Medication Dispenses, Medication Statements and Medication Administrations.
• Systems that could query – EMR, Pharmacy, EHR
• Systems that could respond – Central respository (Rx, EHR, DIS, HIE) or local system (EHR, eRx, Pharmacy)

• Discussion of the definition of a medication profile
• The following table was developed using AU, NL, CAN and IHE information:

Element	NL (standard practice enforced by infrastructure)	Can (In 1 jurisdiction)	IHE Pharmacy (on profile)	Australia (standard practice)
=================	=================	=================	=================	=================
Prescribed Meds	yes	yes	yes	Yes
Dispensed Meds	Yes	Yes	-	Yes
Administered Med	Yes	No	-	Yes
Medication Statements	Yes	Yes	Yes (and dietary	Yes
Use of alcohol and other drugs	Yes – under consideration to remove	No – although may be on local profile, but not DIS	-	Yes
Labs	Yes	No – not part of DIS, but may be retrieved from other system	-	Yes
Indications for use	Yes	Yes (but would be part of prescription record)	Diagnosis	Yes
Contraindications – conditions	Yes	No	-	Yes
Contraindications – allergy/intolerances and reaction	Yes	Yes	-	Yes
Reason for stop/start	Yes	Yes (but would be part of prescription record)	-	Yes
Name of the prescriber	Yes	Yes (but would be part of prescription record)	-	No
Original Prescriber	Yes	No	-	No
Name of Pharmacist	Yes	Yes (but would be part of dispense)	-	No
Patient – ID and demographics	Yes	Yes	Yes	Yes
Management of detected issues	No	No	No	Yes
Patient preferences	No	No	No	Yes

• It was determined that the committee can work on a set of queries to retrieve the information that is in our purview - Prescriptions, Dispenses, Administrations, Statements.
• John drafted the following statement that was agreed to by the attendees:
• The Pharmacy WG is responsible for defining the content e.g. Medication Queries that may populate a Medication Profile or Medication List. We acknowledge that one definition of a Medication Profile may include a broad range of data such as lab results, allergies and intolerance, height, weight, etc. However the Pharmacy WG will focus on queries for Medication Orders, Medication Dispenses, Medication Administrations and Medication Statements.
• Pharmacy WG also acknowledges there are several processes that are common when evaluating Medication information for a patient. We often see Medication Review and Medication Reconciliation steps called out as processes that clinicians will perform. In both cases, the clinician will need access to the type of content we provide via our Medication queries.
• Work was begun on a PSS for Patient Medication Queries but it was not completed and will be brought back at a later meeting.

Baltimore

In table above:

• Added Preference related to medication as a required topic within the profile
• Add managed contra-indications to the required items list

Atlanta

Ballot presentation to be done:

1) Standard Message ballot

• jean/Hugh will check on cross linkages in ballots with MnM.

2) Ballot templates for use by Structured Documents

• John has asked Gaye if this can be done? Waiting for response

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Message Ballot Content

• Introduction
  • The Pharmacy WG is responsible for defining the content e.g. Medication Queries that may populate a Medication Profile or Medication List. We acknowledge that one definition of a Medication Profile may include a broad range of data such as lab results, allergies and intolerance, height, weight, etc. However the Pharmacy WG will focus on queries for Medication Orders, Medication Dispenses, Medication Administrations and Medication Statements.
  • Pharmacy WG also acknowledges there are several processes that are common when evaluating Medication information for a patient. We often see Medication Review and Medication Reconciliation steps called out as processes that clinicians will perform. In both cases, the clinician will need access to the type of content we provide via our Medication queries.

Introduction must be broad and explain how the other topics in the ballot tie back into this topic.

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Assets

• We have
  • Medication Order
  • Medication Dispense
  • medication Administration
  • medication Administration Query
  • medication Statement
  • medication Statement Query
  • Patient related medication query (Sept 2007 informative appendix)
  • Generic patient related pharmacy query topic (May 2007 - R1)

• We don't have
  • Medication Order Query
  • Medication Dispense Query
  • Big bang query equivalent
  • Point in time query

Note: All queries will be patient based otherwise its not a Medication Profile

• Storyboards

Pull Process

This s the use of all the existing queries to pull together information already held in repositories. Need to described scenarios where information is generataed. OP gets prescription, has it dispensed and then reports it when admitted to hospital - describe the means of acquiring thr full information at each point of this process. Ifrastructure has an effect on level of detal required un query responses.

Push Process

All information is sent to next carer in chain so they have full information. Assume information is accumulated; put a timestamp on it and send it on its way.

Storyboards will point to RMIMs and interactions in other topics.

Tom suggests a medication profile will be used in Transfer of Care cases, in which case we will need more application roles.

Mother of all queries will be in this topic.

• Application Roles
  • Medication Profile requester
  • Responder

• Trigger Events
  • We only need one trigger event for all interactions

• RMIMs
  • Big bang query equivalent
  • Point in time query
  • Also text to point readers back to the other topics where the query RMIMs exist.

• Interactions
  • Need to list all the interactions required for Medication Profile

Miscellaneous Material

File:2012-11-02 eMM-Landscape-Concepts-and-Definitions-for-IHE-HL7-Pharmacy.pptx

File:IHE Pharmacy WhitePaper Medication Documentation v09.doc

File:2012-10-24 eMM-Landscape-and Definitions for IHE-HL7-Pharmacy.pptx